Background: Despite rapid advances in the management of preterm infants,
periventricular leukomalacia (PVL) remains a considerable problem in
neonatal intensive care. The aim of this study was to determine whether
hypocarbia is associated with the development of PVL in mechanically
ventilated, preterm infants and to emphasize the importance of avoiding
this disturbance.
Methods: The authors evaluated 52 mechanically ventilated infants with a
gestational age of <34 weeks, who exhibited hypocarbia in the first
three postnatal days (lowest carbon dioxide tension being <25 mmHg).
These infants were then compared with 52 infants in a control group not
exhibiting hypocarbia, matched for birthweight and gestational age. A
diagnosis of PVL was made on the basis of the results of cranial
ultrasonography. Confounding factors potentially associated with the
development of PVL were controlled in logistic regression analyses.
Results: Of the 52 mechanically ventilated preterm infants with
hypocarbia, 10 (19.2%) developed cystic PVL, and six (11.5%) developed
periventricular echodensity. Of the 52 infants in the control group only
two (3.8%) developed cystic PVL, and one (1.9%) infant developed
periventricular echodensity. The authors observed no significant
differences in other prenatal and perinatal risk factors between the two
groups.
Conclusion: Hypocarbia in mechanically ventilated preterm infants during
the first days of life is suggested as being an independent predictor of
PVL, predisposing these infants to subsequent neurodevelopmental delay
