High blood carbon dioxide variability and adverse outcomes in neonatal hypoxic ischemic encephalopathy

作者：Hansen Gregory^*; Al Shafouri Nasser; Narvey Michael; Vallance Jeff K; Srinivasan Ganesh

来源：Journal of Maternal-Fetal and Neonatal Medicine, 2016, 29(4): 680-683.

DOI：10.3109/14767058.2015.1015983

• Asphyxia
• blood gas analysis
• hypothermia
• infant
• treatment outcomes

Objective: Hypocarbia during the first 12h of life is associated with mortality and disability in neonatal hypoxic ischemic encephalopathy (HIE). Notable variation in arterial carbon dioxide tension (PaCO2) during the first 4d of life is related to severe intraventricular hemorrhages in preterm infants. We examined the association between PaCO2 during 72h of whole-body therapeutic hypothermia for neonatal HIE and 2-year neurodevelopmental outcomes.Methods: A retrospective review of 23 term neonates treated with whole-body hypothermia documented clinical, demographic and arterial blood gas data. Comparisons were made across good and severe neurodevelopmental outcome groups at 2 years of age.Results: Severe neurodevelopmental outcomes were documented in 8 of 23 toddlers. There were no significant differences between outcome groups with regard to the number of patients with hypocarbic means or measurements. There were also no significant differences with mean PaCO2, PaO2, pH, time-weighted cumulative hypocarbia, and PaCO2 range. The severe neurodevelopmental outcomes group had a significantly higher mean PaCO2 standard deviation (p=0.04; 95% CI, -5.46 to -0.39).Conclusion: Severe neurodevelopmental outcomes were significantly associated with high PaCO2 variability over 72h in whole-body-cooled HIE neonates. Mitigating these fluctuations may be a potential management strategy.

• 出版日期2016-2-16