Department of Neonatology, University of Massachusetts Medical School, Worcester, MA, USA.
Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA.
Pediatr Res. 2021 Oct;90(4):840-846. doi: 10.1038/s41390-020-01308-2. Epub 2021 Jan 19.
Chronic lung disease remains a burden for extremely preterm infants. The changes in ventilation over time and optimal ventilatory management remains unknown. Newer, non-invasive technologies provide insight into these patterns.
This single-center prospective cohort study enrolled infants ≤32 0/7 weeks. We obtained epochs of transcutaneous carbon dioxide (TcCO) measurements twice each week to describe the pattern of hypercarbia throughout their hospitalization.
Patterns of hypercarbia varied based on birth gestational age and post-menstrual age (PMA) (p = 0.03), regardless of respiratory support. Infants receiving the most respiratory support had values 16-21 mmHg higher than those on room air (p < 0.001). Infants born at the youngest gestational ages had the greatest total change but the rate of change was slower (p = 0.049) compared to infants born at later gestational ages. All infants had TcCO values stabilize by 31-33 weeks PMA, when values were not significantly different compared to discharge. No rebound was observed when infants weaned off invasive support.
Hypercarbia improves as infants approached 31-33 weeks PMA. Hypercarbia was the highest in the most immature infants and improved with age and growth despite weaning respiratory support.
This study describes the evolution of hypercarbia as very preterm infants grow and develop. The pattern of ventilation is significantly different depending on the gestational age at birth and post-menstrual age. Average transcutaneous carbon dioxide (TCO) decreased over time as infants became more mature despite weaning respiratory support. This improvement was most significant in infants born at the lowest gestational ages.
慢性肺部疾病仍然是极早产儿的负担。随着时间的推移，通气方式的变化和最佳通气管理仍然未知。更新的、非侵入性的技术为这些模式提供了深入的了解。
这项单中心前瞻性队列研究纳入了≤32 0/7 周的婴儿。我们每两周获得两次经皮二氧化碳（TcCO）测量的时间段，以描述他们住院期间高碳酸血症的模式。
高碳酸血症的模式因出生胎龄和孕周后（PMA）而异（p=0.03），与呼吸支持无关。接受最多呼吸支持的婴儿比在空气环境中呼吸的婴儿高 16-21mmHg（p<0.001）。胎龄最小的婴儿总变化最大，但变化速度较慢（p=0.049），而胎龄较大的婴儿则变化较快。所有婴儿的 TcCO 值在 31-33 周 PMA 时稳定，与出院时相比没有显著差异。当婴儿停止使用有创支持时，没有观察到反弹。
随着婴儿接近 31-33 周 PMA，高碳酸血症得到改善。在最不成熟的婴儿中，高碳酸血症最高，并且随着年龄和生长而改善，尽管呼吸支持的脱机。
这项研究描述了极早产儿生长和发育过程中高碳酸血症的演变。通气模式因出生胎龄和 PMA 而有显著差异。尽管呼吸支持脱机，但随着婴儿变得更加成熟，平均经皮二氧化碳（TCO）随时间逐渐降低。在胎龄最低的婴儿中，这种改善最为显著。
