Intraventricular haemorrhage (IVH) and bronchopulmonary dysplasia (BPD) are major complications of premature birth. We tested the hypotheses that prematurely born infants who developed an IVH or BPD would have high expiratory tidal volumes (VTE) (VTE > 6 ml/kg) and/or low-end tidal carbon dioxide (ETCO2) levels (ETCO2 levels < 4.5 kPa) as recorded by respiratory function monitoring or hyperoxia (oxygen saturation (SaO2) > 95%) during resuscitation in the delivery suite. Seventy infants, median gestational age 27 weeks (range 23–33), were assessed; 31 developed an IVH and 43 developed BPD. Analysis was undertaken of 31,548 inflations. The duration of resuscitation did not differ significantly between the groups. Those who developed an IVH compared to those who did not had a greater number of inflations with a high VTE and a low ETCO2, which remained significant after correcting for differences in gestational age and birth weight between groups (p = 0.019). Differences between infants who did and did not develop BPD were not significant after correcting for differences in gestational age and birth weight. There were no significant differences in the duration of hyperoxia between the groups.
Conclusions: Avoidance of high tidal volumes and hypocarbia in the delivery suite might reduce IVH development.
What is known
• Hypocarbia on the neonatal unit is associated with the development of intraventricular haemorrhage (IVH) and bronchopulmonary dysplasia (BPD).
What is new
• Infants who developed an IVH compared to those who did not had significantly more inflations with high expiratory tidal volumes and low ETCO2s.
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- CO2 :
- ETCO2 :
End tidal carbon dioxide
- FiO2 :
Inspired oxygen fraction
Positive end expiratory pressure
- VT :
- VTE :
Expiratory tidal volumes
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Dr. Murthy was supported by a grant from the Guy’s and St Thomas’ Charity. Dr. Bhat and Dr. Hunt were supported by a grant from the Charles Wolfson Charitable Trust. Additionally, Dr. Hunt was supported by SLE. The research was supported by the National Institute for Health Research (NIHR) Biomedical Research Centre based at Guy’s and St Thomas’ NHS Foundation Trust and King’s College London. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Infants whose parents gave informed, written consent were recruited.
Conflict of interest
The authors declare that they have no conflict of interest.
Anoop Pahuja and Katie Hunt are joint first authors.
Communicated by Patrick Van Reempts
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Pahuja, A., Hunt, K., Murthy, V. et al. Relationship of resuscitation, respiratory function monitoring data and outcomes in preterm infants. Eur J Pediatr 177, 1617–1624 (2018). https://doi.org/10.1007/s00431-018-3222-y
- Bronchopulmonary dysplasia
- Intraventricular haemorrhage