- 作者：Athina Pappas ; Seetha Shankaran ; Abbot R. Laptook ; John C. Langer ; Rebecca Bara ; Richard A. Ehrenkranz ; Ronald N. Goldberg ; Abhik Das ; Rosemary D. Higgins ; Jon E. Tyson ; Michele C. Walsh ; Eunice Kennedy Shriver National Institute of Child Health ; Human Development Neonatal Research Network
- 刊名：The Journal of Pediatrics
- 出版年：2011
- 出版时间：May 2011
- 年：2011
- 卷：158
- 期：5
- 页码：752-758.e1
- 全文大小：184 K
Objective
To evaluate the association between early hypocarbia and 18- to 22-month outcome among neonates with hypoxic-ischemic encephalopathy.Study design
Data from the National Institute of Child Health and Human Development Neonatal Research Network randomized, controlled trial of whole-body hypothermia for neonatal hypoxic-ischemic encephalopathy were used for this secondary observational study. Infants (n = 204) had multiple blood gases recorded from birth to 12 hours of study intervention (hypothermia versus intensive care alone). The relationship between hypocarbia and outcome (death/disability at 18 to 22 months) was evaluated by unadjusted and adjusted analyses examining minimum PCO2 and cumulative exposure to PCO2 <35 mm Hg. The relationship between cumulative PCO2 <35 mm Hg (calculated as the difference between 35 mm Hg and the sampled PCO2 multiplied by the duration of time spent <35 mm Hg) and outcome was evaluated by level of exposure (none-high) using a multiple logistic regression analysis with adjustments for pH, level of encephalopathy, treatment group (±hypothermia), and time to spontaneous respiration and ventilator days; results were expressed as odds ratios and 95 % confidence intervals. Alternative models of CO2 concentration were explored to account for fluctuations in CO2.
Results
Both minimum PCO2 and cumulative PCO2 <35 mm Hg were associated with poor outcome (P < .05). Moreover, death/disability increased with greater cumulative exposure to PCO2 <35 mm Hg.
Conclusions
Hypocarbia is associated with poor outcome after hypoxic-ischemic encephalopathy.