Is the partial pressure of carbon dioxide in the blood related to the development of retinopathy of prematurity?

AIMS—To determine the role of carbon dioxide in the development of retinopathy of prematurity (ROP).
METHODS—This was a retrospective cohort study of 25 consecutive infants admitted to the neonatal unit with continuously recorded physiological data. The daily mean and standard deviation (SD) of transcutaneous carbon dioxide partial pressure (tcPCO(2)) was compared between infants who had stage 1 or 2 ROP and stage 3 ROP. The time spent hypocarbic (<3 kPa) and/or hypercarbic (>10 kPa and >12 kPa) was also compared between these groups. Intermittent arterial carbon dioxide tension was also measured and compared with the simultaneous tcPCO(2) data.
RESULTS—There were no significant differences in carbon dioxide variability or time spent hypocarbic and/or hypercarbic between the ROP groups on any day. 86% of transcutaneous values were within 1.5 kPa of the simultaneous arterial value.
CONCLUSION—TcPCO(2) measurement can be a very useful management technique. However, in this cohort neither variable blood carbon dioxide tension nor duration of hypercarbia or hypocarbia in the first 2 weeks of life was associated with the development or severity of ROP.


Guideline-directed medical therapy use and decision making in chronic and acute, pre-existing and de novo, heart failure with reduced, mildly reduced, and preserved ejection fraction – the ESC EORP Heart Failure III Registry

Funding Information: This work was supported by the following companies since the start of EORP and for the period of the ESC Heart Failure III study: Abbott Vascular Int. (2018\u20132021), Amgen Cardiovascular (2016\u20132018), AstraZeneca AB (2017\u20132020), Bayer AG (2016\u20132018), Boehringer Ingelheim (2016\u20132019), Bristol Myers Squibb (2017\u20132019), Daichii Sankyo Europe GmbH (2017\u20132020), Edwards Lifesciences (2016\u20132019), Novartis Pharma AG (2018\u20132020), Servier (2015\u20132021), and Vifor (2019\u20132021). Publisher Copyright: © 2024 European Society of Cardiology.Aims: We analysed baseline characteristics and guideline-directed medical therapy (GDMT) use and decisions in the European Society of Cardiology (ESC) Heart Failure (HF) III Registry. Methods and results: Between 1 November 2018 and 31 December 2020, 10 162 patients with acute HF (AHF, 39%, age 70 [62–79], 36% women) or outpatient visit for HF (61%, age 66 [58–75], 33% women), with HF with reduced (HFrEF, 57%), mildly reduced (HFmrEF, 17%) or preserved (HFpEF, 26%) ejection fraction were enrolled from 220 centres in 41 European or ESC-affiliated countries. With AHF, 97% were hospitalized, 2.2% received intravenous treatment in the emergency department, and 0.9% received intravenous treatment in an outpatient clinic. AHF was seen by most by a general cardiologist (51%) and outpatient HF most by a HF specialist (48%). A majority had been hospitalized for HF before, but 26% of AHF and 6.1% of outpatient HF had de novo HF. Baseline use, initiation and discontinuation of GDMT varied according to AHF versus outpatient HF, de novo versus pre-existing HF, and by ejection fraction. After the AHF event or outpatient HF visit, use of any renin–angiotensin system inhibitor, angiotensin receptor–neprilysin inhibitor, beta-blocker, mineralocorticoid receptor antagonist and loop diuretics was 89%, 29%, 92%, 78%, and 85% in HFrEF; 89%, 9.7%, 90%, 64%, and 81% in HFmrEF; and 77%, 3.1%, 80%, 48%, and 80% in HFpEF. Conclusion: Use and initiation of GDMT was high in cardiology centres in Europe, compared to previous reports from cohorts and registries including more primary care and general medicine and regions more local or outside of Europe and ESC-affiliated countries.publishersversionepub_ahead_of_prin

Effect of high versus low initial doses of L-thyroxine for congenital hypothyroidism on thyroid function and somatic growth

&lt;p&gt;&lt;b&gt;Background and aims:&lt;/b&gt; The optimal dose of thyroxine (T4) in congenital hypothyroidism (CH) during infancy is controversial. Higher doses lead to improvement in cognitive scores, but have been linked to later behavioural difficulties. We have examined the effects of initial T4 dosage on somatic growth - a putative surrogate marker of overtreatment.&lt;/p&gt; &lt;p&gt;&lt;b&gt;Methods:&lt;/b&gt; 314 CH children (214 girls, 100 boys) were analysed according to initial daily dose of T4: Group 1 (25 μgg, n=152), Group 2 (30-40μgg, n=63) and Group 3 (50 μgg , n=99). Thyroid function and weight, length and occipito-frontal head circumference (OFC) SDS were compared at 3, 6, 12, 18, 24 and 36 months of age. Linear growth SDS was compared between the three groups using a regression adjustment model at 12 and 18 months of age using birth weight and 3 month data as baselines. Thyroid function was also compared at diagnosis (T0), and 7-21 days after the start of treatment (T1).&lt;/p&gt; &lt;p&gt;&lt;b&gt;Results:&lt;/b&gt; At T1 median TSH for Groups 1, 2 and 3 was 58, 29 and 4.1 mU/L respectively (p &#60;0.001), Group 3 values remaining significantly lower at 3 and 6 months. Median fT4 was within or just above the reference range in all groups at T1, but 7.4% of Group 1 had values &#60; 9 pmol/L compared with 5.1% and 0% for Groups 2 and 3 respectively. At 3 months weight, length and OFC SDS values were -0.39, -0.35, 0.09; -0.30, -0.47, 0.32; and -0.03, -0.13, 0.18 for Groups 1, 2 and 3 respectively, indicating relatively large OFC in all infants. A regression adjustment model showed no significant difference in growth rate from baseline and 12 or 18 months of age between the three groups.&lt;/p&gt; &lt;p&gt;&lt;b&gt;Conclusion:&lt;/b&gt; An initial T4 dose of 50 μgg daily normalises thyroid function several months earlier than lower dose regimes, with no evidence of sustained somatic overgrowth between 3 months and 3 years.&lt;/p&gt