PaCO2 and neurodevelopment in extremely low birth weight infants.
OBJECTIVE
To determine the relationship between PaCO2 in the first 4 days of life and neurodevelopment at 18 to 22 months.


METHODS
Stepwise regression and exhaustive CHAID (Chi-squared Automatic Interaction Detector) analyses were done for neurodevelopmental impairment (NDI), mental developmental index (MDI), and psychomotor developmental index (PDI) using clinical variables in combination with the maximum (max), time-weighted average (avg), and max-minimum (max-min) PaCO2 in 400 infants of 401 to 1000 g birth weight (BW).


RESULTS
By regression, NDI predictors were male sex, non-Caucasian race, premature prolonged rupture of membranes (PPROM), lower BW, IVH 3 to 4, and lower 1-minute Apgar score. For lower MDI, predictors were male sex, non-Caucasian race, PPROM, IVH 3 to 4, sepsis, and higher max-min PaCO2. For lower PDI, predictors were male sex, PPROM, lower BW, IVH 3 to 4, sepsis, and higher avg PaCO2. By CHAID, the most important predictor of NDI was sex. For MDI, sex was most important followed by max-min PaCO2 >42 mm Hg in boys. For PDI, IVH was most important, followed by max-min PaCO2 >42 mm Hg for grade < or = 2 IVH.


CONCLUSIONS
Extreme fluctuations in PaCO2 and higher max PaCO2 are associated with worse neurodevelopmental outcomes and may indicate either a greater severity of illness or contribution of PaCO2 to pathophysiology of adverse neurodevelopment.
McKee
Lara A
LA
Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL 35233, USA.
Fabres
Jorge
J
Howard
George
G
Peralta-Carcelen
Myriam
M
Carlo
Waldemar A
WA
Ambalavanan
Namasivayam
N
D001724:Birth Weight / Q000502:physiology; D002245:Carbon Dioxide / Q000097:blood*; D002658:Developmental Disabilities / Q000097:blood* / Q000503:physiopathology*; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000503:physiopathology; D006801:Humans; D052577:Infant, Extremely Low Birth Weight / Q000502:physiology*; D007231:Infant, Newborn; D020300:Intracranial Hemorrhages / Q000503:physiopathology; D008297:Male; D015999:Multivariate Analysis; D011247:Pregnancy; D011597:Psychomotor Performance / Q000502:physiology; D044469:Racial Groups; D018805:Sepsis / Q000503:physiopathology; D012737:Sex Factors
D002245:Carbon Dioxide