Pa co2 and Neurodevelopment in Extremely Low Birth Weight Infants

• Published in: The Journal of pediatrics Vol. 155; no. 2; pp. 217 - 221.e1
• Main Authors: McKee, Lara A., MD, Fabres, Jorge, MD, MSPH, Howard, George, DrPH, Peralta-Carcelen, Myriam, MD, Carlo, Waldemar A., MD, Ambalavanan, Namasivayam, MD
• Format: Journal Article
• Language: English
• Published: 2009
• Subjects: Pediatrics; Cerebral palsy; CPAP; CHAID; Chi-squared Automatic Interaction Detector; PVL; Bayley Scales of Infant Development II; Necrotizing enterocolitis; Gestational age; NDI; MDI; PDI; BW; GA; Mental developmental index; ELBW; Psychomotor developmental index; Extremely low birth weight; Pregnancy induced hypertension; Continuous positive airway pressure; Neurodevelopmental impairment; Intraventricular hemorrhage; CP; Intermittent mechanical ventilation; NEC; PIH; P a co 2; IMV; Periventricular leukomalacia; BSID II; BPD; Bronchopulmonary dysplasia; Birth weight; IVH; Partial pressure of arterial carbon dioxide; Premature prolonged rupture of membranes; PPROM
• ISSN: 0022-3476
• DOI: 10.1016/j.jpeds.2009.02.024

Objective To determine the relationship between Pa co2 in the first 4 days of life and neurodevelopment at 18 to 22 months. Study design 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) Pa co2 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 Pa co2 . For lower PDI, predictors were male sex, PPROM, lower BW, IVH 3 to 4, sepsis, and higher avg Pa co2 . By CHAID, the most important predictor of NDI was sex. For MDI, sex was most important followed by max-min Pa co2 >42 mm Hg in boys. For PDI, IVH was most important, followed by max-min Pa co2 >42 mm Hg for grade ≤2 IVH. Conclusions Extreme fluctuations in Pa co2 and higher max Pa co2 are associated with worse neurodevelopmental outcomes and may indicate either a greater severity of illness or contribution of Pa co2 to pathophysiology of adverse neurodevelopment.