Significance of hypocarbia in the development of periventricular leukomalacia in preterm infants.
BACKGROUND
Despite rapid advances in the management of preterm infants, periventricular leukomalacia (PVL) remains a considerable problem in neonatal intensive care. The aim of this study was to determine whether hypocarbia is associated with the development of PVL in mechanically ventilated, preterm infants and to emphasize the importance of avoiding this disturbance.


METHODS
The authors evaluated 52 mechanically ventilated infants with a gestational age of <34 weeks, who exhibited hypocarbia in the first three postnatal days (lowest carbon dioxide tension being <25 mmHg). These infants were then compared with 52 infants in a control group not exhibiting hypocarbia, matched for birthweight and gestational age. A diagnosis of PVL was made on the basis of the results of cranial ultrasonography. Confounding factors potentially associated with the development of PVL were controlled in logistic regression analyses.


RESULTS
Of the 52 mechanically ventilated preterm infants with hypocarbia, 10 (19.2%) developed cystic PVL, and six (11.5%) developed periventricular echodensity. Of the 52 infants in the control group only two (3.8%) developed cystic PVL, and one (1.9%) infant developed periventricular echodensity. The authors observed no significant differences in other prenatal and perinatal risk factors between the two groups.


CONCLUSIONS
Hypocarbia in mechanically ventilated preterm infants during the first days of life is suggested as being an independent predictor of PVL, predisposing these infants to subsequent neurodevelopmental delay.
Giannakopoulou
Christina
C
Department of Neonatology, University of Crete, Greece. aligisak@med.uoc.gr
Korakaki
Eftichia
E
Manoura
Antonia
A
Bikouvarakis
Stellios
S
Papageorgiou
Maria
M
Gourgiotis
Dimitrios
D
Hatzidaki
Eleftheria
E
D016022:Case-Control Studies; D005260:Female; D006801:Humans; D016857:Hypocapnia / Q000150:complications*; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000097:blood* / Q000000981:diagnostic imaging / Q000209:etiology; D007969:Leukomalacia, Periventricular / Q000097:blood* / Q000000981:diagnostic imaging / Q000209:etiology; D008297:Male; D012121:Respiration, Artificial; D012307:Risk Factors; D014463:Ultrasonography