PaCO2 in Surfactant, Positive Pressure, and Oxygenation Randomised Trial (SUPPORT)

Namasivayam Ambalavanan; Waldemar A Carlo; Lisa A Wrage; Abhik Das; Matthew Laughon; C Michael Cotten; Kathleen A Kennedy; Abbot R Laptook; Seetha Shankaran; Michele C Walsh; Rosemary D Higgins; SUPPORT Study Group of the NICHD Neonatal Research Network

doi:10.1136/archdischild-2014-306802

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PaCO2 in Surfactant, Positive Pressure, and Oxygenation Randomised Trial (SUPPORT)

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PaCO2 in Surfactant, Positive Pressure, and Oxygenation Randomised Trial (SUPPORT)

Namasivayam Ambalavanan, Waldemar A Carlo, Lisa A Wrage, Abhik Das, Matthew Laughon, C Michael Cotten, Kathleen A Kennedy, Abbot R Laptook, Seetha Shankaran, Michele C Walsh, …

Archives of disease in childhood. Fetal and neonatal edition, Vol.100(2), pp.F145-F149

03/2015

DOI: 10.1136/archdischild-2014-306802

PMCID: PMC4336211

PMID: 25425651

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Abstract

Objective To determine the association of arterial partial pressure of carbon dioxide PaCO2 with severe intraventricular haemorrhage (sIVH), bronchopulmonary dysplasia (BPD), and neurodevelopmental impairment (NDI) at 18–22 months in premature infants. Design Secondary exploratory data analysis of Surfactant, Positive Pressure, and Oxygenation Randomised Trial (SUPPORT). Setting Multiple referral neonatal intensive care units. Patients 1316 infants 24 0/7 to 27 6/7 weeks gestation randomised to different oxygenation (SpO2 target 85–89% vs 91–95%) and ventilation strategies. Main outcome measures Blood gases from postnatal day 0 to day14 were analysed. Five PaCO2 variables were defined: minimum (Min), maximum (Max), SD, average (time-weighted), and a four level categorical variable (hypercapnic (highest quartile of Max PaCO2), hypocapnic (lowest quartile of Min PaCO2), fluctuators (hypercapnia and hypocapnia), and normocapnic (middle two quartiles of Max and Min PaCO2)). PaCO2 variables were compared for infants with and without sIVH, BPD and NDI (±death). Multivariable logistic regression models were developed for adjusted results. Results sIVH, BPD and NDI (±death) were associated with hypercapnic infants and fluctuators. Association of Max PaCO2 and outcomes persisted after adjustment (per 10 mm Hg increase: sIVH/death: OR 1.27 (1.13 to 1.41); BPD/death: OR 1.27 (1.12 to 1.44); NDI/death: OR 1.23 (1.10 to 1.38), death: OR 1.27 (1.12 to 1.44), all p<0.001). No interaction was found between PaCO2 category and SpO2 treatment group for sIVH/death, NDI/death or death. Max PaCO2 was positively correlated with maximum FiO2 (rs0.55, p<0.0001) and ventilator days (rs0.61, p<0.0001). Conclusions Higher PaCO2 was an independent predictor of sIVH/death, BPD/death and NDI/death. Further trials are needed to evaluate optimal PaCO2 targets for high-risk infants.

Details

Title: Subtitle: PaCO2 in Surfactant, Positive Pressure, and Oxygenation Randomised Trial (SUPPORT)
Creators: Namasivayam Ambalavanan - Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA
Waldemar A Carlo - Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA
Lisa A Wrage - Social, Statistical and Environmental Sciences Unit, RTI International, Research Triangle Park, North Carolina, USA
Abhik Das - Social, Statistical and Environmental Sciences Unit, RTI International, Rockville, Maryland, USA
Matthew Laughon - Department of Pediatrics, University of North Carolina, Chapel Hill, North Carolina, USA
C Michael Cotten - Department of Pediatrics, Duke University, Durham, North Carolina, USA
Kathleen A Kennedy - Department of Pediatrics, University of Texas Medical School at Houston, Houston, Texas, USA
Abbot R Laptook - Department of Pediatrics, Women and Infants Hospital, Providence, Rhode Island, USA
Seetha Shankaran - Department of Pediatrics, Wayne State University, Detroit, Michigan, USA
Michele C Walsh - Department of Pediatrics, Rainbow Babies & Children's Hospital, Case Western Reserve University, Cleveland, Ohio, USA
Rosemary D Higgins - Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
SUPPORT Study Group of the NICHD Neonatal Research Network (Institution)
Contributors: Tarah T Colaizy (Contributor) - University of Iowa, Stead Family Department of Pediatrics
Jonathan M Klein (Contributor) - University of Iowa, Stead Family Department of Pediatrics
Resource Type: Journal article
Publication Details: Archives of disease in childhood. Fetal and neonatal edition, Vol.100(2), pp.F145-F149
DOI: 10.1136/archdischild-2014-306802
PMID: 25425651
PMCID: PMC4336211
NLM abbreviation: Arch Dis Child Fetal Neonatal Ed
ISSN: 1359-2998
eISSN: 1468-2052
Language: English
Date published: 03/2015
Academic Unit: Stead Family Department of Pediatrics; Neonatology
Record Identifier: 9984093228602771

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