• 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, and Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network.
• Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI 48201, USA. apappas@med.wayne.edu
• J. Pediatr. 2011 May 1;158(5):752-758.e1.

ObjectiveTo evaluate the association between early hypocarbia and 18- to 22-month outcome among neonates with hypoxic-ischemic encephalopathy.Study DesignData 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 PCO(2) and cumulative exposure to PCO(2) <35 mm Hg. The relationship between cumulative PCO(2) <35 mm Hg (calculated as the difference between 35 mm Hg and the sampled PCO(2) 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 CO(2) concentration were explored to account for fluctuations in CO(2).ResultsBoth minimum PCO(2) and cumulative PCO(2) <35 mm Hg were associated with poor outcome (P < .05). Moreover, death/disability increased with greater cumulative exposure to PCO(2) <35 mm Hg.ConclusionsHypocarbia is associated with poor outcome after hypoxic-ischemic encephalopathy.Copyright © 2011 Mosby, Inc. All rights reserved.

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