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Effects of permissive hypercapnia on pulmonary and neurodevelopmental sequelae in extremely low birth weight infants:
1Department of Pediatrics, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310000 People's Republic of China.
Insights
Permissive hypercapnia did not reduce bronchopulmonary dysplasia (BPD) or mortality in extremely low birth weight infants. This meta-analysis found no significant benefits for BPD, mortality, or neurodevelopmental outcomes.
Area of Science:
- Neonatal medicine
- Respiratory physiology
- Clinical trial analysis
Background:
- Extremely low birth weight (ELBW) infants face significant respiratory challenges.
- Permissive hypercapnia is a ventilation strategy aimed at minimizing lung injury.
Purpose of the Study:
- To systematically review and meta-analyze the efficacy and safety of permissive hypercapnia in ELBW infants.
- To assess the impact of permissive hypercapnia on key neonatal morbidities and mortality.
Main Methods:
- Systematic search of major medical databases (MEDLINE, EMBASE, Cochrane).
- Inclusion and quality assessment of randomized trials.
- Data extraction on study design, patient characteristics, and outcomes.
Main Results:
- Four trials with 693 ELBW infants were analyzed.
- Permissive hypercapnia showed no significant effect on reducing bronchopulmonary dysplasia (BPD) rates.
- No significant differences were observed in mortality, intraventricular hemorrhage (IVH), periventricular leukomalacia (PVL), necrotizing enterocolitis (NEC), retinopathy of prematurity (ROP), or neurodevelopmental outcomes.
Conclusions:
- Permissive hypercapnia does not reduce BPD rates in ELBW infants.
- This ventilation strategy did not significantly impact mortality or major neonatal morbidities.
- Current evidence suggests no additional benefits of permissive hypercapnia for ELBW infants.
Objectives:
To perform a systematic review and meta-analysis of the efficacy and safety of permissive hypercapnia in extremely low birth weight infants.
Methods:
A systematic search of MEDLINE, EMBASE, the Cochrane Database of randomized trials. Eligibility and quality of trials were assessed, and data on study design, patient characteristics, and relevant outcomes were extracted.
Results:
Four studies that enrolled a total of 693 participants were selected. Meta-analysis revealed no effect of permissive hypercapnia on decreasing rates of bronchopulmonary dysplasia (BPD). Permissive hypercapnia also had no significant effect on mortality, intraventricular haemorrhage (IVH), IVH (grade 3-4), periventricular leukomalacia (PVL), necrotising enterocolitis (NEC), retinopathy of prematurity (ROP) or air leaks in extremely low birth weight infants. Neurodevelopmental outcomes were comparable at 18-22 months' corrected age in two studies. permissive hypercapnia did not increase the risk of cerebral palsy, Mental Developmental Index <70, Psychomotor Developmental Index <70, visual deficit, or hearing deficit.
Conclusions:
Permissive hypercapnia did not reduce the rate of BPD in extremely low birth weight infants. The rates of mortality, IVH, PVL, NEC, ROP and neurodevelopmental outcomes did not differ between these two groups. These results suggest that permissive hypercapnia does not bring extra benefits in extremely low birth weight infants.
