PaCO2 in surfactant, positive pressure, and oxygenation randomised trial (SUPPORT)

The SUPPORT Study Group of the NICHD Neonatal Research Network

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Objective: To determine the association of arterial partial pressure of carbon dioxide PaCO2with severe intraventricular haemorrhage (sIVH), bronchopulmonary dysplasia (BPD), and neurodevelopmental impairment (NDI) at 18-22 months in premature infants. Design: Secondary exploratory data analysis of Surfactant, Positive Pressure, and Oxygenation Randomised Trial (SUPPORT). Setting Patients: Multiple referral neonatal intensive care units. 1316 infants 24 0/7 to 27 6/7 weeks gestation randomised to different oxygenation (SpO2target 85-89% vs 91-95%) and ventilation strategies. Main outcome measures: Blood gases from postnatal day 0 to day14 were analysed. Five PaCO2variables were defined: minimum (Min), maximum (Max), SD, average (time-weighted), and a four level categorical variable (hypercapnic (highest quartile of Max PaCO2), hypocapnic (lowest quartile of Min PaCO2), fluctuators (hypercapnia and hypocapnia), and normocapnic (middle two quartiles of Max and Min PaCO2)). PaCO2variables were compared for infants with and without sIVH, BPD and NDI (±death). Multivariable logistic regression models were developed for adjusted results. Results: sIVH, BPD and NDI (±death) were associated with hypercapnic infants and fluctuators. Association of Max PaCO2and outcomes persisted after adjustment (per 10 mm Hg increase: sIVH/death: OR 1.27 (1.13 to 1.41); BPD/death: OR 1.27 (1.12 to 1.44); NDI/death: OR 1.23 (1.10 to 1.38), death: OR 1.27 (1.12 to 1.44), all p<0.001). No interaction was found between PaCO2category and SpO2treatment group for sIVH/death, NDI/death or death. Max PaCO2was positively correlated with maximum FiO2(rs0.55, p<0.0001) and ventilator days (rs0.61, p<0.0001). Conclusions: Higher PaCO2was an independent predictor of sIVH/death, BPD/death and NDI/death. Further trials are needed to evaluate optimal PaCO2targets for high-risk infants.

Original languageEnglish
Pages (from-to)F145-F149
JournalArchives of Disease in Childhood: Fetal and Neonatal Edition
Volume100
Issue number2
DOIs
StatePublished - Mar 1 2015
Externally publishedYes

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Surface-Active Agents
Pressure
Bronchopulmonary Dysplasia
Hemorrhage
Logistic Models
Hypocapnia
Hypercapnia
Partial Pressure
Neonatal Intensive Care Units
Mechanical Ventilators
Premature Infants
Carbon Dioxide
Ventilation
Arterial Pressure
Referral and Consultation
Gases
Outcome Assessment (Health Care)
Pregnancy

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynecology

Cite this

PaCO2 in surfactant, positive pressure, and oxygenation randomised trial (SUPPORT). / The SUPPORT Study Group of the NICHD Neonatal Research Network.

In: Archives of Disease in Childhood: Fetal and Neonatal Edition, Vol. 100, No. 2, 01.03.2015, p. F145-F149.

Research output: Contribution to journalArticle

The SUPPORT Study Group of the NICHD Neonatal Research Network. / PaCO2 in surfactant, positive pressure, and oxygenation randomised trial (SUPPORT). In: Archives of Disease in Childhood: Fetal and Neonatal Edition. 2015 ; Vol. 100, No. 2. pp. F145-F149.
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abstract = "Objective: To determine the association of arterial partial pressure of carbon dioxide PaCO2with severe intraventricular haemorrhage (sIVH), bronchopulmonary dysplasia (BPD), and neurodevelopmental impairment (NDI) at 18-22 months in premature infants. Design: Secondary exploratory data analysis of Surfactant, Positive Pressure, and Oxygenation Randomised Trial (SUPPORT). Setting Patients: Multiple referral neonatal intensive care units. 1316 infants 24 0/7 to 27 6/7 weeks gestation randomised to different oxygenation (SpO2target 85-89{\%} vs 91-95{\%}) and ventilation strategies. Main outcome measures: Blood gases from postnatal day 0 to day14 were analysed. Five PaCO2variables were defined: minimum (Min), maximum (Max), SD, average (time-weighted), and a four level categorical variable (hypercapnic (highest quartile of Max PaCO2), hypocapnic (lowest quartile of Min PaCO2), fluctuators (hypercapnia and hypocapnia), and normocapnic (middle two quartiles of Max and Min PaCO2)). PaCO2variables were compared for infants with and without sIVH, BPD and NDI (±death). Multivariable logistic regression models were developed for adjusted results. Results: sIVH, BPD and NDI (±death) were associated with hypercapnic infants and fluctuators. Association of Max PaCO2and outcomes persisted after adjustment (per 10 mm Hg increase: sIVH/death: OR 1.27 (1.13 to 1.41); BPD/death: OR 1.27 (1.12 to 1.44); NDI/death: OR 1.23 (1.10 to 1.38), death: OR 1.27 (1.12 to 1.44), all p<0.001). No interaction was found between PaCO2category and SpO2treatment group for sIVH/death, NDI/death or death. Max PaCO2was positively correlated with maximum FiO2(rs0.55, p<0.0001) and ventilator days (rs0.61, p<0.0001). Conclusions: Higher PaCO2was an independent predictor of sIVH/death, BPD/death and NDI/death. Further trials are needed to evaluate optimal PaCO2targets for high-risk infants.",
author = "{The SUPPORT Study Group of the NICHD Neonatal Research Network} and Namasivayam Ambalavanan and Carlo, {Waldemar A.} and Wrage, {Lisa A.} and Abhik Das and Matthew Laughon and Cotten, {C. Michael} and Kennedy, {Kathleen A.} and Laptook, {Abbot R.} and Seetha Shankaran and Walsh, {Michele C.} and Higgins, {Rosemary D.} and Jobe, {Alan H.} and Caplan, {Michael S.} and William Oh and Vohr, {Betty R.} and Hensman, {Angelita M.} and Stephens, {Bonnie E.} and Barbara Alksninis and Barnett, {Susan G.} and Cashore, {William J.} and Melinda Caskey and Gargus, {Regina A.} and Gingras, {Daniel J.} and Katharine Johnson and Shabnam Lainwala and Leach, {Theresa M.} and Leonard, {Martha R.} and Sarah Lillie and Moore, {James R.} and Lucy Noel and Walden, {Rachel V.} and Watson, {Victoria E.} and Fanaroff, {Avroy A.} and Wilson-Costello, {Deanne E.} and Newman, {Nancy S.} and Siner, {Bonnie S.} and Arlene Zadell and {Di Fiore}, Juliann and Monika Bhola and Friedman, {Harriet G.} and Gulgun Yalcinkaya and Kurt Schibler and Donovan, {Edward F.} and Kimberly Yolton and Kate Bridges and Barbara Alexander and Cathy Grisby and Mersmann, {Marcia Worley} and Shahnaz Duara and Bauer, {Charles R}",
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T1 - PaCO2 in surfactant, positive pressure, and oxygenation randomised trial (SUPPORT)

AU - The SUPPORT Study Group of the NICHD Neonatal Research Network

AU - Ambalavanan, Namasivayam

AU - Carlo, Waldemar A.

AU - Wrage, Lisa A.

AU - Das, Abhik

AU - Laughon, Matthew

AU - Cotten, C. Michael

AU - Kennedy, Kathleen A.

AU - Laptook, Abbot R.

AU - Shankaran, Seetha

AU - Walsh, Michele C.

AU - Higgins, Rosemary D.

AU - Jobe, Alan H.

AU - Caplan, Michael S.

AU - Oh, William

AU - Vohr, Betty R.

AU - Hensman, Angelita M.

AU - Stephens, Bonnie E.

AU - Alksninis, Barbara

AU - Barnett, Susan G.

AU - Cashore, William J.

AU - Caskey, Melinda

AU - Gargus, Regina A.

AU - Gingras, Daniel J.

AU - Johnson, Katharine

AU - Lainwala, Shabnam

AU - Leach, Theresa M.

AU - Leonard, Martha R.

AU - Lillie, Sarah

AU - Moore, James R.

AU - Noel, Lucy

AU - Walden, Rachel V.

AU - Watson, Victoria E.

AU - Fanaroff, Avroy A.

AU - Wilson-Costello, Deanne E.

AU - Newman, Nancy S.

AU - Siner, Bonnie S.

AU - Zadell, Arlene

AU - Di Fiore, Juliann

AU - Bhola, Monika

AU - Friedman, Harriet G.

AU - Yalcinkaya, Gulgun

AU - Schibler, Kurt

AU - Donovan, Edward F.

AU - Yolton, Kimberly

AU - Bridges, Kate

AU - Alexander, Barbara

AU - Grisby, Cathy

AU - Mersmann, Marcia Worley

AU - Duara, Shahnaz

AU - Bauer, Charles R

PY - 2015/3/1

Y1 - 2015/3/1

N2 - Objective: To determine the association of arterial partial pressure of carbon dioxide PaCO2with severe intraventricular haemorrhage (sIVH), bronchopulmonary dysplasia (BPD), and neurodevelopmental impairment (NDI) at 18-22 months in premature infants. Design: Secondary exploratory data analysis of Surfactant, Positive Pressure, and Oxygenation Randomised Trial (SUPPORT). Setting Patients: Multiple referral neonatal intensive care units. 1316 infants 24 0/7 to 27 6/7 weeks gestation randomised to different oxygenation (SpO2target 85-89% vs 91-95%) and ventilation strategies. Main outcome measures: Blood gases from postnatal day 0 to day14 were analysed. Five PaCO2variables were defined: minimum (Min), maximum (Max), SD, average (time-weighted), and a four level categorical variable (hypercapnic (highest quartile of Max PaCO2), hypocapnic (lowest quartile of Min PaCO2), fluctuators (hypercapnia and hypocapnia), and normocapnic (middle two quartiles of Max and Min PaCO2)). PaCO2variables were compared for infants with and without sIVH, BPD and NDI (±death). Multivariable logistic regression models were developed for adjusted results. Results: sIVH, BPD and NDI (±death) were associated with hypercapnic infants and fluctuators. Association of Max PaCO2and outcomes persisted after adjustment (per 10 mm Hg increase: sIVH/death: OR 1.27 (1.13 to 1.41); BPD/death: OR 1.27 (1.12 to 1.44); NDI/death: OR 1.23 (1.10 to 1.38), death: OR 1.27 (1.12 to 1.44), all p<0.001). No interaction was found between PaCO2category and SpO2treatment group for sIVH/death, NDI/death or death. Max PaCO2was positively correlated with maximum FiO2(rs0.55, p<0.0001) and ventilator days (rs0.61, p<0.0001). Conclusions: Higher PaCO2was an independent predictor of sIVH/death, BPD/death and NDI/death. Further trials are needed to evaluate optimal PaCO2targets for high-risk infants.

AB - Objective: To determine the association of arterial partial pressure of carbon dioxide PaCO2with severe intraventricular haemorrhage (sIVH), bronchopulmonary dysplasia (BPD), and neurodevelopmental impairment (NDI) at 18-22 months in premature infants. Design: Secondary exploratory data analysis of Surfactant, Positive Pressure, and Oxygenation Randomised Trial (SUPPORT). Setting Patients: Multiple referral neonatal intensive care units. 1316 infants 24 0/7 to 27 6/7 weeks gestation randomised to different oxygenation (SpO2target 85-89% vs 91-95%) and ventilation strategies. Main outcome measures: Blood gases from postnatal day 0 to day14 were analysed. Five PaCO2variables were defined: minimum (Min), maximum (Max), SD, average (time-weighted), and a four level categorical variable (hypercapnic (highest quartile of Max PaCO2), hypocapnic (lowest quartile of Min PaCO2), fluctuators (hypercapnia and hypocapnia), and normocapnic (middle two quartiles of Max and Min PaCO2)). PaCO2variables were compared for infants with and without sIVH, BPD and NDI (±death). Multivariable logistic regression models were developed for adjusted results. Results: sIVH, BPD and NDI (±death) were associated with hypercapnic infants and fluctuators. Association of Max PaCO2and outcomes persisted after adjustment (per 10 mm Hg increase: sIVH/death: OR 1.27 (1.13 to 1.41); BPD/death: OR 1.27 (1.12 to 1.44); NDI/death: OR 1.23 (1.10 to 1.38), death: OR 1.27 (1.12 to 1.44), all p<0.001). No interaction was found between PaCO2category and SpO2treatment group for sIVH/death, NDI/death or death. Max PaCO2was positively correlated with maximum FiO2(rs0.55, p<0.0001) and ventilator days (rs0.61, p<0.0001). Conclusions: Higher PaCO2was an independent predictor of sIVH/death, BPD/death and NDI/death. Further trials are needed to evaluate optimal PaCO2targets for high-risk infants.

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