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Impact of Changing Clinical Practices on Early Blood Gas Analyses in Very Preterm Infants and Their Associated Inpatient Outcomes

BACKGROUND: Early studies suggest an association of abnormal carbon dioxide (PCO(2)) or oxygen (PO(2)) levels with adverse inpatient outcomes in very preterm babies. Recent resuscitation practice changes, such as targeted oxygen therapy, end-expiratory pressure, and rescue surfactant may influence t...

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Autores principales: Huang, Hongmei, Cheung, Po-Yin, O’Reilly, Megan, van Os, Sylvia, Solevåg, Anne Lee, Aziz, Khalid, Schmölzer, Georg M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5303872/
https://www.ncbi.nlm.nih.gov/pubmed/28243581
http://dx.doi.org/10.3389/fped.2017.00011
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author Huang, Hongmei
Cheung, Po-Yin
O’Reilly, Megan
van Os, Sylvia
Solevåg, Anne Lee
Aziz, Khalid
Schmölzer, Georg M.
author_facet Huang, Hongmei
Cheung, Po-Yin
O’Reilly, Megan
van Os, Sylvia
Solevåg, Anne Lee
Aziz, Khalid
Schmölzer, Georg M.
author_sort Huang, Hongmei
collection PubMed
description BACKGROUND: Early studies suggest an association of abnormal carbon dioxide (PCO(2)) or oxygen (PO(2)) levels with adverse inpatient outcomes in very preterm babies. Recent resuscitation practice changes, such as targeted oxygen therapy, end-expiratory pressure, and rescue surfactant may influence these associations. OBJECTIVE: The aim of this study is to assess the range of the initial partial pressures of PCO(2) and PO(2) in preterm neonates <33 weeks gestational age after birth and their correlation to inpatient neonatal outcomes. STUDY DESIGN: This is a prospective observational cohort study of infants <33 weeks gestational age with arterial or venous blood gas analysis performed within the first hour after birth. RESULTS: One hundred seventy infants (arterial n = 75, venous n = 95) with mean (SD) gestational age of 28 (3) weeks and birth weight of 1,111 (403) g were included. None of the infants with arterial blood gases had hypocarbia (<30 mmHg), 32 (43%) had normocarbia (30–55 mmHg), and 43 (57%) had hypercarbia (>55 mmHg). Seventeen of the infants with arterial blood gases (22%) had hypoxia (<50 mmHg), 50 (67%) normoxia, and 8 (11%) hyperoxia (>80 mmHg). In infants with venous blood samples, none had venous PCO(2) < 40 mmHg, 41 (43%) had venous PCO(2) 40–60 mmHg, and 54 (57%) had venous PCO(2) > 60 mmHg. Multivariable logistic regression analysis showed no association of low or high PCO(2) or PO(2) with death or major inpatient morbidities. CONCLUSION: With current resuscitation and stabilization practices, hyperoxia and hypocarbia was uncommon, and hypercarbia occurred frequently. None of these findings correlate with adverse inpatient outcomes or death. Our findings are in direct contrast to published observations using historical practices.
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spelling pubmed-53038722017-02-27 Impact of Changing Clinical Practices on Early Blood Gas Analyses in Very Preterm Infants and Their Associated Inpatient Outcomes Huang, Hongmei Cheung, Po-Yin O’Reilly, Megan van Os, Sylvia Solevåg, Anne Lee Aziz, Khalid Schmölzer, Georg M. Front Pediatr Pediatrics BACKGROUND: Early studies suggest an association of abnormal carbon dioxide (PCO(2)) or oxygen (PO(2)) levels with adverse inpatient outcomes in very preterm babies. Recent resuscitation practice changes, such as targeted oxygen therapy, end-expiratory pressure, and rescue surfactant may influence these associations. OBJECTIVE: The aim of this study is to assess the range of the initial partial pressures of PCO(2) and PO(2) in preterm neonates <33 weeks gestational age after birth and their correlation to inpatient neonatal outcomes. STUDY DESIGN: This is a prospective observational cohort study of infants <33 weeks gestational age with arterial or venous blood gas analysis performed within the first hour after birth. RESULTS: One hundred seventy infants (arterial n = 75, venous n = 95) with mean (SD) gestational age of 28 (3) weeks and birth weight of 1,111 (403) g were included. None of the infants with arterial blood gases had hypocarbia (<30 mmHg), 32 (43%) had normocarbia (30–55 mmHg), and 43 (57%) had hypercarbia (>55 mmHg). Seventeen of the infants with arterial blood gases (22%) had hypoxia (<50 mmHg), 50 (67%) normoxia, and 8 (11%) hyperoxia (>80 mmHg). In infants with venous blood samples, none had venous PCO(2) < 40 mmHg, 41 (43%) had venous PCO(2) 40–60 mmHg, and 54 (57%) had venous PCO(2) > 60 mmHg. Multivariable logistic regression analysis showed no association of low or high PCO(2) or PO(2) with death or major inpatient morbidities. CONCLUSION: With current resuscitation and stabilization practices, hyperoxia and hypocarbia was uncommon, and hypercarbia occurred frequently. None of these findings correlate with adverse inpatient outcomes or death. Our findings are in direct contrast to published observations using historical practices. Frontiers Media S.A. 2017-02-13 /pmc/articles/PMC5303872/ /pubmed/28243581 http://dx.doi.org/10.3389/fped.2017.00011 Text en Copyright © 2017 Huang, Cheung, O’Reilly, van Os, Solevåg, Aziz and Schmölzer. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Pediatrics
Huang, Hongmei
Cheung, Po-Yin
O’Reilly, Megan
van Os, Sylvia
Solevåg, Anne Lee
Aziz, Khalid
Schmölzer, Georg M.
Impact of Changing Clinical Practices on Early Blood Gas Analyses in Very Preterm Infants and Their Associated Inpatient Outcomes
title Impact of Changing Clinical Practices on Early Blood Gas Analyses in Very Preterm Infants and Their Associated Inpatient Outcomes
title_full Impact of Changing Clinical Practices on Early Blood Gas Analyses in Very Preterm Infants and Their Associated Inpatient Outcomes
title_fullStr Impact of Changing Clinical Practices on Early Blood Gas Analyses in Very Preterm Infants and Their Associated Inpatient Outcomes
title_full_unstemmed Impact of Changing Clinical Practices on Early Blood Gas Analyses in Very Preterm Infants and Their Associated Inpatient Outcomes
title_short Impact of Changing Clinical Practices on Early Blood Gas Analyses in Very Preterm Infants and Their Associated Inpatient Outcomes
title_sort impact of changing clinical practices on early blood gas analyses in very preterm infants and their associated inpatient outcomes
topic Pediatrics
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5303872/
https://www.ncbi.nlm.nih.gov/pubmed/28243581
http://dx.doi.org/10.3389/fped.2017.00011
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