Neonatal encephalopathy therapy optimization for better neuroprotection with inhalation of CO2: the HENRIC feasibility and safety trial

Eniko Szakmar, Kata Kovacs, Unoke Meder, Geza Bokodi, Csilla Andorka, Andrea Lakatos, Attila J. Szabo, Gusztav Belteki, Miklos Szabo, Agnes Jermendy

Research output: Contribution to journalArticle

Abstract

Background: There is an association between hypocapnia and adverse neurodevelopmental outcome in infants with neonatal encephalopathy (NE). Our aim was to test the safety and feasibility of 5% CO2 and 95% air inhalation to correct hypocapnia in mechanically ventilated infants with NE undergoing therapeutic hypothermia. Methods: Ten infants were assigned to this open-label, single-center trial. The gas mixture of 5% CO2 and 95% air was administered through patient circuits if the temperature-corrected PCO2 ≤40 mm Hg. The CO2 inhalation was continued for 12 h or was stopped earlier if the base deficit (BD) level decreased <5 mmol/L. Follow-up was performed using Bayley Scales of Infant Development II. Results: The patients spent a median 95.1% (range 44.6–98.5%) of time in the desired PCO2 range (40–60 mm Hg) during the inhalation. All PCO2 values were >40 mm Hg, the lower value of the target range. Regression modeling revealed that BD and lactate had a tendency to decrease during the intervention (by 0.61 and 0.55 mmol/L/h, respectively), whereas pH remained stable. The rate of moderate disabilities and normal outcome was 50%. Conclusions: Our results suggest that inhaled 5% CO2 administration is a feasible and safe intervention for correcting hypocapnia.

Original languageEnglish
Pages (from-to)1025-1032
Number of pages8
JournalPediatric research
Volume87
Issue number6
DOIs
Publication statusPublished - May 1 2020

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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    Szakmar, E., Kovacs, K., Meder, U., Bokodi, G., Andorka, C., Lakatos, A., Szabo, A. J., Belteki, G., Szabo, M., & Jermendy, A. (2020). Neonatal encephalopathy therapy optimization for better neuroprotection with inhalation of CO2: the HENRIC feasibility and safety trial. Pediatric research, 87(6), 1025-1032. https://doi.org/10.1038/s41390-019-0697-9