title: Acidemia versus hypercapnia and risk for severe intraventricular hemorrhage.
abstract: In extremely low birth weight (ELBW) infants, levels of hypercapnia (Paco 2) > 60 mm Hg are considered a risk factor for severe intraventricular hemorrhage (IVH). Since cerebral vasoreactivity depends on arterial pH (apH) rather than Paco 2, we hypothesize that the role of mild-to-moderate hypercapnia (45-60 mm Hg) in the occurrence of severe IVH is modulated by the metabolic component of acid-base status. ELBW infants (n = 580, born < 28 wk gestation, and BW < 1,000 g) were separated into "high-base deficit (BD)" (n = 291) and "low-BD" (n = 289) groups if infants' median BD were > 4 mEq/L or ≤4 mEq/L, respectively. Rates of severe IVH were higher in "high-BD" (16%) than "low-BD" (9%) group. Although adjusted risk for severe IVH increased with higher Paco 2 and higher BD, apH was the sole predictor of severe IVH. In ELBW infants, higher degree of acidemia, rather than hypercapnia per se, during the first 48 hours of life, is associated with higher occurrences of severe IVH.
authors.affiliation: Division of Neonatology, Department of Pediatrics, University of South Alabama, Mobile, Alabama.
authors.forename: Michael Maurice
authors.initials: MM
authors.lastname: Zayek
authors.affiliation: Department of Pediatrics, University of South Alabama, Mobile, Alabama.
authors.forename: Wael
authors.initials: W
authors.lastname: Alrifai
authors.affiliation: Division of Neonatology, Department of Pediatrics, University of South Alabama, Mobile, Alabama.
authors.forename: Richard Marion
authors.initials: RM
authors.lastname: Whitehurst
authors.affiliation: Department of Pediatrics, University of South Alabama, Mobile, Alabama.
authors.forename: Kok Lim
authors.initials: KL
authors.lastname: Kua
authors.affiliation: Division of Pediatric Neurosurgery, Department of Surgery, University of South Alabama, Mobile, Alabama.
authors.forename: Anthony
authors.initials: A
authors.lastname: Martino
authors.affiliation: Division of Neonatology, Department of Pediatrics, University of South Alabama, Mobile, Alabama.
authors.forename: Fabien Gabriel
authors.initials: FG
authors.lastname: Eyal
mesh_terms: D000138:Acidosis / Q000453:epidemiology*; D002543:Cerebral Hemorrhage / Q000453:epidemiology*; D002552:Cerebral Ventricles; D005260:Female; D006801:Humans; D006935:Hypercapnia / Q000453:epidemiology*; D052577:Infant, Extremely Low Birth Weight; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index