Both Extremes of Arterial Carbon Dioxide Pressure and the Magnitude of Fluctuations in Arterial Carbon Dioxide Pressure Are Associated With Severe Intraventricular Hemorrhage in Preterm Infants
2007; American Academy of Pediatrics; Volume: 119; Issue: 5 Linguagem: Inglês
10.1542/peds.2007-0353
ISSN1098-4275
Autores Tópico(s)Neonatal Respiratory Health Research
ResumoTo the Editor.—I read the recent article by Fabres et al1 with great interest. The authors of the study observed that hypocapnia, extreme hypercapnia, and fluctuations of Paco2 in premature infants with birth weights of 401 to 1250 g during the first 4 days of life are associated with severe intraventricular hemorrhage (IVH). The authors correctly pointed out that avoiding extremes of Paco2 during the period when these infants are at highest risk for developing IVH may be prudent. I am pleased that their work nicely expands on the observations from my study group that hypercapnia during the first 3 days of life is associated with severe IVH in very low birth weight infants.2Disturbed cerebral blood flow and cerebral autoregulation are considered to play important roles in the development of IVH.3–5 With respect to the role that hypercapnia may play in the etiology of severe IVH, my study group was the first to show in premature infants during the first week of life that increasing Paco2 is associated with progressively impaired cerebral autoregulation.6 Thus, because Paco2 is an important regulator of cerebral blood flow,7 we suggest a plausible mechanism for the association of early hypercapnia and development for IVH.I compliment Fabres et al,1 because their work importantly adds to the burgeoning literature on the potential negative effects of extremes of Paco2 during the early neonatal period in extremely premature infants.This research was supported by National Institute of Neurological Disorders and Stroke grant 1 K23 NS43185.
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