PaCO2 in Surfactant, Positive Pressure, and Oxygenation Randomised Trial (SUPPORT). Issue 2 (25th November 2014)

• Record Type: Journal Article
• Authors: Ambalavanan, Namasivayam; Carlo, Waldemar A; Wrage, Lisa A; Das, Abhik; Laughon, Matthew; Cotten, C Michael; Kennedy, Kathleen A; Laptook, Abbot R; Shankaran, Seetha; Walsh, Michele C; Higgins, Rosemary D
• Other Names: Jobe Alan H collab.; Caplan Michael S collab.; Oh William collab.; Vohr Betty R collab.; Hensman Angelita M collab.; Stephens Bonnie E collab.; Alksninis Barbara collab.; Barnett Susan G collab.; Cashore William J collab.; Caskey Melinda collab.; Gargus Regina A collab.; Gingras Daniel J collab.; Johnson Katharine collab.; Lainwala Shabnam collab.; Leach Theresa M collab.; Leonard Martha R collab.; Lillie Sarah collab.; Moore James R collab.; Noel Lucy collab.; Walden Rachel V collab.; Watson Victoria E collab.; Fanaroff Avroy A collab.; Wilson-Costello Deanne E collab.; Newman Nancy S collab.; Siner Bonnie S collab.; Zadell Arlene collab.; Fiore Juliann Di collab.; Bhola Monika collab.; Friedman Harriet G collab.; Yalcinkaya Gulgun collab.; Schibler Kurt collab.; Donovan Edward F collab.; Yolton Kimberly collab.; Bridges Kate collab.; Alexander Barbara collab.; Grisby Cathy collab.; Mersmann Marcia Worley collab.; Mincey Holly L collab.; Hessling Jody collab.; Gratton Teresa L collab.; Goldberg Ronald N collab.; Goldstein Ricki F collab.; Ashley Patricia L collab.; Auten Kathy J collab.; Fisher Kimberley A collab.; Foy Katherine A collab.; Freedman Sharon Fridovich collab.; Gustafson Kathryn E collab.; Lohmeyer Melody B collab.; Malcolm William F collab.; Wallace David K collab.; Stoll Barbara J collab.; Buchter Susie collab.; Piazza Anthony J collab.; Carlton David P collab.; Adams-Chapman Ira collab.; Carter Sheena L collab.; Hale Ellen C collab.; Hutchinson Amy K collab.; LaRossa Maureen Mulligan collab.; Archer Stephanie Wilson collab.; Poindexter Brenda B collab.; Dusick Anna M collab.; Lemons James A collab.; Wilson Leslie D collab.; Hamer Faithe collab.; Cook Ann B collab.; Herron Dianne E collab.; Lytle Carolyn collab.; Minnich Heike M collab.; Poole W Kenneth collab.; Gantz Marie G collab.; Newman Jamie E collab.; Hastings Betty K collab.; Auman Jeanette O'Donnell collab.; Huitema Carolyn Petrie collab.; Pickett James W collab.; Wallace Dennis collab.; Zaterka-Baxter Kristin M collab.; Van Meurs Krisa P collab.; Stevenson David K collab.; Hintz Susan R collab.; Ball M Bethany collab.; Bentley Barbara collab.; Bruno Elizabeth F. collab.; Davis Alexis S. collab.; DeAnda Maria Elena collab.; DeBattista Anne M collab.; Kohn Jean G collab.; Proud Melinda S collab.; Pyle Renee P collab.; John Nicholas H St collab.; Weiss Hali E collab.; Frantz Ivan D collab.; Fiascone John M collab.; McGowan Elisabeth C collab.; Furey Anne collab.; MacKinnon Brenda L collab.; Nylen Ellen collab.; Brussa Ana collab.; Sibley Cecelia collab.; Peralta-Carcelen Myriam collab.; Collins Monica V collab.; Cosby Shirley S collab.; Phillips Vivien A collab.; Bailey Kirstin J collab.; Biasini Fred J collab.; Johnston Kristen C collab.; Krzywanski Sara collab.; Nelson Kathleen G collab.; Patterson Cryshelle S collab.; Rector Richard V collab.; Rodrigues Leslie collab.; Soong Amanda D collab.; Whitley Sally collab.; Finer Neil N collab.; Rasmussen Maynard R. collab.; Wozniak Paul R collab.; Vaucher Yvonne E collab.; Rich Wade collab.; Arnell Kathy collab.; Bridge Renee collab.; Demetrio Clarence collab.; Fuller Martha G collab.; Zlotnik Paul collab.; Bell Edward F collab.; Widness John A collab.; Klein Jonathan M collab.; Acarregui Michael J collab.; Colaizy Tarah T collab.; Johnson Karen J collab.; Eastman Diane L collab.; Duara Shahnaz collab.; Bauer Charles R collab.; Everett-Thomas Ruth collab.; Calejo Maria collab.; Diaz Alexis N collab.; Frade Eguaras Silvia M collab.; Garcia Andrea collab.; Hamlin-Smith Kasey collab.; Berkowits Michelle Harwood collab.; Fajardo-Hiriart Sylvia collab.; Mathews Elaine E collab.; Pierre Helina collab.; Riguard Arielle collab.; Stroerger Alexandra collab.; Watterberg Kristi L collab.; Ohls Robin K collab.; Fuller Janell collab.; Lacy Conra Backstrom collab.; Lowe Jean collab.; Montman Rebecca collab.; Phelps Dale L collab.; Myers Gary J collab.; Markowitz Gary David collab.; Reubens Linda J collab.; Hust Diane collab.; Johnson Julie Babish collab.; Burnell Erica collab.; Jensen Rosemary L collab.; Kushner Emily collab.; Merzbach Joan collab.; Yost Kelley collab.; Sánchez Pablo J collab.; Rosenfeld Charles R collab.; Salhab Walid A collab.; Heyne Roy J collab.; Brion Luc P collab.; Adams Sally S collab.; Allen James collab.; Grau Laura collab.; Guzman Alicia collab.; Hensley Gaynelle collab.; Heyne Elizabeth T collab.; Leps Melissa H collab.; Madden Linda A collab.; Martin Melissa Swensen collab.; Miller Nancy A collab.; Morgan Janet S collab.; Solis Araceli collab.; Torres Lizette E collab.; Boatman Catherine Twell collab.; Vasil Diana M collab.; Tyson Jon E collab.; Alaniz Nora I collab.; Evans Patricia W collab.; Harris Beverly Foley collab.; Green Charles collab.; Jiminez Margarita collab.; Lis Anna E collab.; Martin Sarah collab.; McDavid Georgia E collab.; Morris Brenda H collab.; Poundstone Margaret L. collab.; Reddoch Stacy collab.; Siddiki Saba collab.; Tate Patti L. Pierce collab.; Whitely Laura L collab.; Wright Sharon L collab.; Faix Roger G collab.; Yoder Bradley A collab.; Baker Shawna collab.; Bird Karie collab.; Burnett Jill collab.; Osborne Karen A collab.; Spencer Cynthia collab.; Steffen Michael collab.; Weaver-Lewis Kimberlee collab.; O'Shea T Michael collab.; Dillard Robert G collab.; Washburn Lisa K collab.; Peters Nancy J collab.; Jackson Barbara G collab.; Chiu Korinne collab.; Allred Deborah Evans collab.; Goldstein Donald J collab.; Halfond Raquel collab.; Peterson Carroll collab.; Waldrep Ellen L collab.; Welch Cherrie D collab.; Morris Melissa Whalen collab.; Hounshell Gail Wiley collab.; Sood Beena G collab.; Pappas Athina collab.; Bara Rebecca collab.; Goldston Laura A collab.; Johnson Mary E collab.; Ehrenkranz Richard A collab.; Bhandari Vineet collab.; Williams Joanne collab.;
• Is Part Of: Archives of disease in childhood. Volume 100:Issue 2(2015)
• Page Start: F145
• Page End: F149
• Publication Date: 2014-11-25
• Subjects: Neonatology -- Respiratory -- Neurodisability -- Mortality -- Intensive Care; Infants -- Diseases -- Periodicals; Newborn infants -- Diseases -- Periodicals; Fetus -- Diseases -- Periodicals; 618.920105
• DOI: 10.1136/archdischild-2014-306802
• Languages: English
• ISSNs: 1359-2998

Abstract

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 (rs 0.55, p<0.0001) and ventilator days (rs 0.61, 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.