Trends among neonatologists in decision to ventilate preterm infants with permissive hypercapnia

Abstract

Introduction: Despite measures done to avoid neonatal respiratory distress syndrome, many prematurely born infants still suffer from this disease, they are artificially ventilated, or experience long term oxygen dependency and consequently have chronic lung disease/bronchopulmonary dysplasia. One of the proposed measures for shortening of mechanical ventilation is strategy of permissive hypercapnia. There are promising studies, but clear recommendations for this treatment option are still lacking. Aim: The aim of this study is to determine number of patients ventilated by permissive hypercapnia, and to analyze factors that lead neonatologists towards decision to treat preterm infants by this ventilation option. Methods: The present study was conducted in a tertiary research and educational hospital from April 2013 to July 2015. At admission we registered data regarding birth weight, gestational age, Apgar score, prenatally given steroids, mode of delivery, CRIB score. All infants had chest X-ray at admission. When establishing diagnosis of respiratory distress syndrome and conducting its treatment, we followed European Consensus Guidelines on the Management of Neonatal Respiratory Distress Syndrome in Preterm Infants – 2013 Update. After treatment, according to their mean PaCO2 patients were divided into hypercapnia and normocapnia group, and then analyzed. Results: There were 69/158 (43.7%) patients in hypercapnia (HP) group and 89/158 (56.3%) in normocapnia (NC) group. Out of total number of patients 48.7% were female. Mean PCO2 in PH was 7.46 kPa (range 6.3-10.6 kPa). In NC group mean PCO2 was 5.9kPa (range 4.6-7.3kPa). Two groups didn’t differ regarding gestational age, prenatally given steroids, Apgar in 1. and 5.minute, mode of delivery, CRIB score, nor according to level of respiratory distress syndrome, and surfactant use. Group of neonates ventilated by strategy of permissive hypercapnia had significantly higher mean birth weight P=0.029. Conclusion: This study shows that in absence of clear recommendations and defined criteria for implementing strategy of permissive hypercapnia in prematurely born infants, in praxis we find almost half of the babies who have been treated by this mode of respiratory treatment. For this ventilation option neonatologists prefer children with higher birth weight.