Asphyxiated neonates who received active therapeutic hypothermia during transport had higher rates of hypocapnia than controls

Eniko Szakmar, Kata Kovacs, Unoke Meder, Geza Bokodi, Andras Szell, Zsolt Somogyvari, Attila J. Szabo, M. Szabó, Agnes Jermendy

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Aim: We investigated the association between active hypothermia and hypocapnia in neonates with moderate-to-severe hypoxic-ischaemic encephalopathy (HIE) transported after birth. Methods: This was a retrospective cohort study of neonates with HIE born between 2007 and 2011 and transported to Semmelweis University, Hungary, for hypothermia treatment before and after we introduced active cooling during transport in 2009. Of these, 71 received intensive care plus controlled active hypothermia during transport, while the 46 controls just received standard intensive care. Incident hypocapnia was defined as a partial pressure of carbon-dioxide (pCO2) that decreased below 35 mm Hg during transport. Multivariable logistic regression investigated the relationship between hypothermia and incident hypocapnia. Results: Incident hypocapnia was more frequent in the actively cooled transport group (36.6%) than control group (17.4%; p = 0.025). pCO2 decreased from a median of 45 to 35 mm Hg (p < 0.0001) in the intervention group, but remained unchanged in the controls. After adjusting for confounders, hypothermia remained an independent risk factor for hypocapnia with an odds ratio (OR) of 4.23 and 95% confidence interval (95% CI) of 1.30-13.79. Sedation was associated with a reduction in OR of hypocapnia, at 0.35 (95% CI 0.12-0.98). Conclusions: Hypothermia increased the risk of hypocapnia in neonates with HIE during transport.

Original languageEnglish
JournalActa Paediatrica, International Journal of Paediatrics
DOIs
Publication statusAccepted/In press - Jan 1 2018

Fingerprint

Hypocapnia
Induced Hypothermia
Hypothermia
Brain Hypoxia-Ischemia
Critical Care
Odds Ratio
Confidence Intervals
Hungary
Partial Pressure
Carbon Dioxide
Cohort Studies
Retrospective Studies
Logistic Models
Parturition
Control Groups

Keywords

  • Hypocapnia
  • Hypothermia
  • Hypoxic-ischaemic encephalopathy
  • Neonatal transport
  • Neuroprotection

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Asphyxiated neonates who received active therapeutic hypothermia during transport had higher rates of hypocapnia than controls. / Szakmar, Eniko; Kovacs, Kata; Meder, Unoke; Bokodi, Geza; Szell, Andras; Somogyvari, Zsolt; Szabo, Attila J.; Szabó, M.; Jermendy, Agnes.

In: Acta Paediatrica, International Journal of Paediatrics, 01.01.2018.

Research output: Contribution to journalArticle

Szakmar, Eniko ; Kovacs, Kata ; Meder, Unoke ; Bokodi, Geza ; Szell, Andras ; Somogyvari, Zsolt ; Szabo, Attila J. ; Szabó, M. ; Jermendy, Agnes. / Asphyxiated neonates who received active therapeutic hypothermia during transport had higher rates of hypocapnia than controls. In: Acta Paediatrica, International Journal of Paediatrics. 2018.
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abstract = "Aim: We investigated the association between active hypothermia and hypocapnia in neonates with moderate-to-severe hypoxic-ischaemic encephalopathy (HIE) transported after birth. Methods: This was a retrospective cohort study of neonates with HIE born between 2007 and 2011 and transported to Semmelweis University, Hungary, for hypothermia treatment before and after we introduced active cooling during transport in 2009. Of these, 71 received intensive care plus controlled active hypothermia during transport, while the 46 controls just received standard intensive care. Incident hypocapnia was defined as a partial pressure of carbon-dioxide (pCO2) that decreased below 35 mm Hg during transport. Multivariable logistic regression investigated the relationship between hypothermia and incident hypocapnia. Results: Incident hypocapnia was more frequent in the actively cooled transport group (36.6{\%}) than control group (17.4{\%}; p = 0.025). pCO2 decreased from a median of 45 to 35 mm Hg (p < 0.0001) in the intervention group, but remained unchanged in the controls. After adjusting for confounders, hypothermia remained an independent risk factor for hypocapnia with an odds ratio (OR) of 4.23 and 95{\%} confidence interval (95{\%} CI) of 1.30-13.79. Sedation was associated with a reduction in OR of hypocapnia, at 0.35 (95{\%} CI 0.12-0.98). Conclusions: Hypothermia increased the risk of hypocapnia in neonates with HIE during transport.",
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AU - Szakmar, Eniko

AU - Kovacs, Kata

AU - Meder, Unoke

AU - Bokodi, Geza

AU - Szell, Andras

AU - Somogyvari, Zsolt

AU - Szabo, Attila J.

AU - Szabó, M.

AU - Jermendy, Agnes

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N2 - Aim: We investigated the association between active hypothermia and hypocapnia in neonates with moderate-to-severe hypoxic-ischaemic encephalopathy (HIE) transported after birth. Methods: This was a retrospective cohort study of neonates with HIE born between 2007 and 2011 and transported to Semmelweis University, Hungary, for hypothermia treatment before and after we introduced active cooling during transport in 2009. Of these, 71 received intensive care plus controlled active hypothermia during transport, while the 46 controls just received standard intensive care. Incident hypocapnia was defined as a partial pressure of carbon-dioxide (pCO2) that decreased below 35 mm Hg during transport. Multivariable logistic regression investigated the relationship between hypothermia and incident hypocapnia. Results: Incident hypocapnia was more frequent in the actively cooled transport group (36.6%) than control group (17.4%; p = 0.025). pCO2 decreased from a median of 45 to 35 mm Hg (p < 0.0001) in the intervention group, but remained unchanged in the controls. After adjusting for confounders, hypothermia remained an independent risk factor for hypocapnia with an odds ratio (OR) of 4.23 and 95% confidence interval (95% CI) of 1.30-13.79. Sedation was associated with a reduction in OR of hypocapnia, at 0.35 (95% CI 0.12-0.98). Conclusions: Hypothermia increased the risk of hypocapnia in neonates with HIE during transport.

AB - Aim: We investigated the association between active hypothermia and hypocapnia in neonates with moderate-to-severe hypoxic-ischaemic encephalopathy (HIE) transported after birth. Methods: This was a retrospective cohort study of neonates with HIE born between 2007 and 2011 and transported to Semmelweis University, Hungary, for hypothermia treatment before and after we introduced active cooling during transport in 2009. Of these, 71 received intensive care plus controlled active hypothermia during transport, while the 46 controls just received standard intensive care. Incident hypocapnia was defined as a partial pressure of carbon-dioxide (pCO2) that decreased below 35 mm Hg during transport. Multivariable logistic regression investigated the relationship between hypothermia and incident hypocapnia. Results: Incident hypocapnia was more frequent in the actively cooled transport group (36.6%) than control group (17.4%; p = 0.025). pCO2 decreased from a median of 45 to 35 mm Hg (p < 0.0001) in the intervention group, but remained unchanged in the controls. After adjusting for confounders, hypothermia remained an independent risk factor for hypocapnia with an odds ratio (OR) of 4.23 and 95% confidence interval (95% CI) of 1.30-13.79. Sedation was associated with a reduction in OR of hypocapnia, at 0.35 (95% CI 0.12-0.98). Conclusions: Hypothermia increased the risk of hypocapnia in neonates with HIE during transport.

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