Outcome of extremely preterm infants randomized at birth to different PaCO2 targets during the first seven days of life.
BACKGROUND
Ventilation with higher PaCO(2) goals may reduce lung injury and bronchopulmonary dysplasia (BPD). The effect may be enhanced by using a higher PaCO(2) goal than in previous trials.


OBJECTIVE
To determine the clinical benefits and safety of higher PaCO(2) goals for ventilated preterm infants.


METHODS
Preterm infants with a gestational age between 23 and 28 completed weeks receiving mechanical ventilation within 6 h of birth were randomized to be managed with either a PaCO(2) target between 55 and 65 mm Hg (7.3- 8.7 kPa, minimal ventilation) or 35 and 45 mm Hg (4.7- 6.0 kPa, routine ventilation) for the first 7 days of life. The primary outcome measure was BPD, defined as need for mechanical ventilation or supplemental oxygen at 36 weeks postmenstrual age, or death. The neurodevelopmental status was assessed at 18-22 months corrected age.


RESULTS
The trial was stopped early after enrolling 31% of the projected sample size. Enrolled infants had a median birth weight of 640 g. BPD or death occurred in 21/33 (64%) infants after minimal ventilation and 19/32 (59%) infants after routine ventilation. Minimal ventilation was associated with trends towards higher mortality and higher incidence of neurodevelopmental impairment, and a significantly increased combined outcome of mental impairment or death (p < 0.05).


CONCLUSIONS
Minimal ventilation as performed in this study did not improve clinical outcome, and may have been associated with a worse neurodevelopmental outcome.
Thome
Ulrich H
UH
Division of Neonatology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Ala., USA. uhthome@web.de
Carroll
William
W
Wu
Tzong-Jin
TJ
Johnson
Robert B
RB
Roane
Claire
C
Young
Daniel
D
Carlo
Waldemar A
WA
D000465:Algorithms; D001921:Brain / Q000254:growth & development; D001997:Bronchopulmonary Dysplasia / Q000401:mortality / Q000517:prevention & control; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D008297:Male; D012121:Respiration, Artificial / Q000379:methods*; D012127:Respiratory Distress Syndrome, Newborn / Q000401:mortality / Q000628:therapy*; D016896:Treatment Outcome