Neonatal Perinatal Medicine, Department of Pediatrics, Georgetown University Hospital, 3800 Reservoir Rd, NW, #M3400, Washington, DC 20007, USA.
Matern Child Health J. 2011 Dec;15 Suppl 1(Suppl 1):S17-26. doi: 10.1007/s10995-011-0863-0.
Bronchopulmonary dysplasia (BPD) continues to be a major pulmonary complication in very low birth weight (VLBW) and extremely low birth weight (ELBW) survivors of neonatal intensive care units (NICUs). Many factors including partial pressures of carbon dioxide (PaCO: (2)) have been implicated as possible causes. Permissive hypercapnia has become a more common practice in ventilated infants, but its effect on BPD is unclear. The hypothesis of this study was that hypercarbia is associated with increased BPD in infants with birth weights of 500-1,499 g. Nine hospitals were involved in this observational cohort study. Maternal and infant information including socio-demographics, antenatal steroids, gender, race, gestational age, birth weight, intubation and ventilator status, physiologic variables and data on therapies were collected by chart abstraction. SNAP scores were assigned. Candidate BPD risk factors, including cumulative exposures derived from blood gas and ventilation data in the first 6 days of life, were identified. Risk models were developed for 425 preterm infants who survived to 36 weeks post-menstrual age. BPD occurrence was associated with the cumulative burden of MAP >0 cm H(2)O in the first 6 days of life (P < 0.0001). After adjustment for the burden of MAP, the occurrence of hypercarbia (PaCO: (2) >50 torr) was associated with a greater incidence of BPD (P = 0.024). Among 293 intubated, mechanically ventilated infants, those with hypercarbia occurring only when MAP ≤ 8 cm H(2)O, a scenario more comparable to permissive hypercapnia, also had increased BPD incidence compared to infants without hypercarbia (P = 0.0003). Hypercarbia during the first 6 days of life was associated with increased incidence of BPD in these infants. Mechanically ventilated infants with hypercarbia during low MAP also had a significant increase in BPD. Permissive hypercapnia in ventilated infants needs further close review before the practice becomes even more widespread.
支气管肺发育不良（BPD）仍然是新生儿重症监护病房（NICU）极低出生体重（VLBW）和超低出生体重（ELBW）幸存者的主要肺部并发症。许多因素，包括二氧化碳分压（PaCO 2 ），都被认为是可能的原因。允许性高碳酸血症在呼吸机辅助通气的婴儿中已成为一种更为常见的做法，但它对 BPD 的影响尚不清楚。本研究的假设是，高碳酸血症与 500-1499g 出生体重的婴儿 BPD 发生率增加有关。该观察性队列研究涉及 9 家医院。通过图表提取收集了包括社会人口统计学、产前类固醇、性别、种族、胎龄、出生体重、插管和呼吸机状态、生理变量以及治疗数据在内的母婴信息。SNAP 评分也被赋值。确定了包括出生后 6 天内血气和通气数据累积暴露在内的候选 BPD 危险因素。为 425 名存活至胎龄 36 周的早产儿开发了风险模型。BPD 的发生与出生后 6 天内 MAP>0cmH 2 O 的累积负担有关（P<0.0001）。在调整 MAP 负担后，高碳酸血症（PaCO 2 >50torr）的发生与 BPD 发生率增加相关（P=0.024）。在 293 名插管、机械通气的婴儿中，当 MAP≤8cmH 2 O 时仅发生高碳酸血症的情况下，这种情况更类似于允许性高碳酸血症，与无高碳酸血症的婴儿相比，BPD 发生率也增加（P=0.0003）。出生后 6 天内的高碳酸血症与这些婴儿 BPD 发生率增加有关。在低 MAP 时发生高碳酸血症的机械通气婴儿，BPD 发生率也显著增加。在接受呼吸机治疗的婴儿中，允许性高碳酸血症需要进一步仔细审查，然后再更广泛地推广。
