Abstract
Infants with bronchopulmonary dysplasia (BPD) are at risk for numerous complications following discharge from the Neonatal Intensive Care Unit (NICU). Few studies have evaluated risk factors for adverse events (AE). This retrospective study provided an initial evaluation of the use of capillary carbon dioxide (PCO2) tension as a predictor of infants with BPD at increased risk for AE. PCO2 was compared in patients who suffered, or avoided, severe AE, defined as pulmonary hypertension, death, or subsequent reintubation or tracheostomy for respiratory illness. One hundred twelve consecutive patients followed at the BPD clinic were evaluated, and data from 104 subjects were suitable for analysis. Mean PCO2, obtained shortly before or after discharge from NICU, was 47.2 mmHg (range, 31–83). PCO2 was significantly higher in patients who required reintubation and ventilation (54.7 vs. 46.7, p < 0.04). No cutoff value of PCO2 clearly distinguished patients with subsequent AE. PCO2 was not significantly higher in the group of patients who had a severe AE than in the group of patients who did not have a severe AE, but logistic regression showed a significant association between PCO2 and risk of both severe AE (p = 0.018), and readmission to hospital (p = 0.038). An elevated PCO2 is associated with an increased risk of AE, including reintubation, and readmission to hospital, in infants with BPD. Patients with an elevated discharge PCO2 may require closer monitoring during followup. Prospective studies will be needed to confirm these observations.
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References
Abman SH, Groothuis JR (1994) Pathophysiology and treatment of bronchopulmonary dysplasia. Current issues. Pediatr Clin North Am 41:277–315
Abman SH, Wolfe RR, Accurso FJ, et al. (1985) Pulmonary vascular response to oxygen in infants with severe bronchopulmonary dysplasia. Pediatrics 75:80–84
Abman SH, Burchell MF, Schaffer MS, Rosenberg AA (1989) Late sudden unexpected deaths in hospitalized infants with bronchopulmonary dysplasia. Am J Dis Child 143:815–819
Alagappan A, Malloy MH (1998) Systemic hypertension in very low-birth weight infants with bronchopulmonary dysplasia: incidence and risk factors. Am J Perinatol 15:3–8
Anwar M, Marotta F, Fort MD, et al. (1993) The ventilatory response to carbon dioxide in high risk infants. Early Hum Dev 35:183–192
Bear R, Goldstein M, Phillipson E, et al. (1977) Effect of metabolic alkalosis on respiratory function in patients with chronic obstructive lung disease. Can Med Assoc J 117:900–903
Brijker F, Heijdra YF, van den Elshout FJ, Folgering HT (2002) Discontinuation of furosemide decreases PaCO(2) in patients with COPD. Chest 121:377–382
Calverley PM (2003) Respiratory failure in chronic obstructive pulmonary disease. Eur Respir J Suppl 47:26s–30s
Doig WB (1971) Value of arterialized capillary blood gas analysis in lower respiratory tract infection in childhood. Arch Dis Child 46:243–246
Dorkin HL (1988) Home Respiratory Care. In: Merritt TA, Northway WH, Boynton BR (eds) Bronchopulmonary Dysplasia. Blackwell Scientific, Boston, pp 331–339
Downing GJ, Kilbride HW (1995) Evaluation of airway complications in high-risk preterm infants: application of flexible fiberoptic airway endoscopy. Pediatrics 95:567–572
Dupont WD, Plummer WD (1990) Power and sample size calculation. A review and computer program. Control Clin Trials 11:116–128
Gray PH, Rogers Y (1994) Are infants with bronchopulmonary dysplasia at risk for sudden infant death syndrome? Pediatrics 93:774–777
Heldt GP (1988) Pulmonary Status of Infants and Children with Bronchopulmonary Dysplasia. In: Merrit TA, Northway WH, Boynton BR (eds) Bronchopulmonary Dysplasia. Blackwell Scientific, Boston, pp 421–438
Hudak BB, Allen MC, Hudak ML, Loughlin GM (1989) Home oxygen therapy for chronic lung disease in extremely low-birth-weight infants. Am J Dis Child 143:357–360
Iles R, Edmunds AT (1996) Prediction of early outcome in resolving chronic lung disease of prematurity after discharge from hospital. Arch Dis Child 74:304–308
Iles R, Edmunds AT (1997) Assessment of pulmonary function in resolving chronic lung disease of prematurity. Arch Dis Child Fetal Neonatal Ed 76:F113–F117
Jewett Jr TC, Siegel M (1984) Hiatal hernia and gastroesophageal reflux. J Pediatr Gastroenterol Nutr 3:340–345
Jobe AH, Bancalari E (2001) NICHD/NHBLI/ORD Workshop Summary. Bronchopulmonary dysplasia. Am J Respir Crit Care Med 163:1723–1729
O’Brodovich HM, Mellins RB (1985) Bronchopulmonary dysplasia. Unresolved neonatal acute lung injury. Am Rev Respir Dis 132:694–709
Palta M, Sadek M, Barnet JH, et al. (1998) Evaluation of criteria for chronic lung disease in surviving very low birth weight infants. Newborn Lung Project. J Pediatr 132:57–63
Palta M, Sadek-Badawi M, Sheehy M, et al. (2001) Respiratory symptoms at age 8 years in a cohort of very low birth weight children. Am J Epidemiol 154:521–529
Pearson ES, Hartley HO (1970) Biometrika Tables for Statisticians, vol I, 3rd ed. Cambridge University Press, Cambridge
Rojas MA, Gonzalez A, Bancalari E, et al. (1995) Changing trends in the epidemiology and pathogenesis of neonatal chronic lung disease. J Pediatr 126:605–610
Shennan AT, Dunn MS, Ohlsson A, Lennox K, Hoskins EM (1988) Abnormal pulmonary outcomes in premature infants: prediction from oxygen requirement in the neonatal period. Pediatrics 82:527–532
Sherman FS (1988) Cor Pulmonale. In: Merritt TA, Northway WH, Boynton BR (eds) Bronchopulmonary Dysplasia. Blackwell Scientific, Boston, pp 251–262
Simakajornboon N, Beckerman RC, Mack C, Sharon D, Gozal D (2002) Effect of supplemental oxygen on sleep architecture and cardiorespiratory events in preterm infants. Pediatrics 110:884–888
Toce SS, Farrell PM, Leavitt LA, Samuels DP, Edwards DK (1984) Clinical and roentgenographic scoring systems for assessing bronchopulmonary dysplasia. Am J Dis Child 138:581–585
Truog WE, Jackson JC, Badura RJ, et al. (1985) Bronchopulmonary dysplasia and pulmonary insufficiency of prematurity. Lack of correlation of outcome with gas exchange abnormalities at 1 month of age. Am J Dis Child 139:351–354
Walsh MC, Wilson-Costello D, Zadell A, Newman N, Fanaroff A (2003) Safety, reliability, and validity of a physiologic definition of bronchopulmonary dysplasia. J Perinatol 23:451–456
Wang EE, Law BJ, Stephens D (1995) Pediatric Investigators Collaborative Network on Infections in Canada (PICNIC) prospective study of risk factors and outcomes in patients hospitalized with respiratory syncytial viral lower respiratory tract infection. J Pediatr 126:212–219
Wolfson MR, Bhutani VK, Shaffer TH, Bowen Jr FW (1984) Mechanics and energetics of breathing helium in infants with bronchopulmonary dysplasia. J Pediatr 104:752–757
Wu CH, Chou HC, Hsieh WS, et al. (2003) Good estimation of arterial carbon dioxide by end-tidal carbon dioxide monitoring in the neonatal intensive care unit. Pediatr Pulmonol 35:292–295
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The work was funded by the Ontario Thoracic Society.
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Kovesi, T., Abdurahman, A. & Blayney, M. Elevated Carbon Dioxide Tension as a Predictor of Subsequent Adverse Events in Infants with Bronchopulmonary Dysplasia. Lung 184, 7–13 (2006). https://doi.org/10.1007/s00408-005-2556-1
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DOI: https://doi.org/10.1007/s00408-005-2556-1