title: Severe Intraventricular Hemorrhage in Extremely Premature Infants: Are high Carbon Dioxide Pressure or Fluctuations the Culprit?
abstract: OBJECTIVE
  This study aims to examine the association between measures of hypercapnia and fluctuation in Pco 2 and severe intraventricular hemorrhage (IVH) and to evaluate the prevalence of hypercapnia, hypocapnia, and fluctuations in Pco 2 in the initial 72 hours of life among premature infants.
  
  
  METHODS
  Retrospective study of premature infants with birth weight < 1,250 g, who were receiving some respiratory support. All blood gases obtained in the first 3 days of life were collected. Univariate and multivariate analyses were performed to assess the association of hypercapnia, and fluctuations in Pco 2 with severe IVH.
  
  
  RESULTS
  Our cohort included 285 patients, of whom 84% were intubated. Only 20% patients had all blood gases in the normocapnia range; 9% had at least 1 gas with hypercapnia; 51% had at least 1 gas with hypocapnia, and 20% patients had both hypercapnia and hypocapnia at different times. Infants with severe IVH (n = 41) had significantly higher peak Pco 2 and greater fluctuations in Pco 2 within a short interval, compared with those without severe IVH (n = 227). After controlling for gestational age, gender, antenatal steroid exposure, presence of hypercapnia, and Apgar score at 5 minutes, fluctuation in Pco 2 remained significantly associated with severe IVH.
  
  
  CONCLUSIONS
  Fluctuations in Pco 2 within a short period may be more significantly associated with severe IVH than the mere presence of hypercapnia.
authors.affiliation: Division of Neonatal Perinatal Medicine, Hutzel Women's Hospital, Wayne State University, Detroit, Michigan.
authors.forename: Dima
authors.initials: D
authors.lastname: Altaany
authors.affiliation: Division of Neonatal Perinatal Medicine, Hutzel Women's Hospital, Wayne State University, Detroit, Michigan.
authors.forename: Girija
authors.initials: G
authors.lastname: Natarajan
authors.affiliation: Department of Pediatrics, Wayne State University, Detroit, Michigan.
authors.forename: Dhruv
authors.initials: D
authors.lastname: Gupta
authors.affiliation: Department of Pediatrics, Wayne State University, Detroit, Michigan.
authors.forename: Marwan
authors.initials: M
authors.lastname: Zidan
authors.affiliation: Division of Neonatal Perinatal Medicine, Hutzel Women's Hospital, Wayne State University, Detroit, Michigan.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Chawla
mesh_terms: D001034:Apgar Score; D001724:Birth Weight; D001784:Blood Gas Analysis; D002245:Carbon Dioxide / Q000097:blood*; D002543:Cerebral Hemorrhage / Q000453:epidemiology*; D005260:Female; D005865:Gestational Age; D006801:Humans; D006935:Hypercapnia / Q000097:blood*; D016857:Hypocapnia / Q000097:blood*; D062071:Infant, Extremely Premature / Q000097:blood*; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight / Q000097:blood*; D016015:Logistic Models; D008297:Male; D012189:Retrospective Studies
chemical_list: D002245:Carbon Dioxide