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Carbon dioxide levels in neonates: what are safe parameters?
Sie Kei Wong1, M Chim1, J Allen1,2
1Department of Paediatrics, School of Medicine, Trinity College, The University of Dublin, Trinity Translational Medicine Institute (TTMI) & Trinity Research in Childhood Centre (TRiCC), Dublin, Ireland.
Pediatric Research
|July 7, 2021
Summary
Optimal newborn carbon dioxide (CO2) levels lack consensus. This review found no clear benefits of permissive hypercapnia and suggests a safe range of 5-7 kPa for CO2 in neonates.
Area of Science:
- Neonatal medicine
- Pediatric respiratory care
- Clinical neonatology
Background:
- Optimal partial pressure of carbon dioxide (pCO2) levels in newborns remain debated.
- Existing research on hypercapnia and hypocapnia presents varied outcomes and lacks definitive safe thresholds.
- Understanding the impact of CO2 levels is crucial for managing neonatal respiratory conditions.
Purpose of the Study:
- To systematically review the effects of hypercapnia and hypocapnia on neonatal outcomes.
- To evaluate existing carbon dioxide thresholds and the effectiveness of permissive hypercapnia.
- To infer a safe pCO2 range for newborns based on available evidence.
Main Methods:
- Systematic review adhering to PRISMA and MOOSE guidelines.
- Screening of 299 studies, with 37 included for analysis.
- Utilized Covidence software for efficient article management.
Main Results:
- Hypocapnia is primarily linked to neurological side effects.
- Hypercapnia is associated with neurological, respiratory, gastrointestinal issues, and retinopathy of prematurity (ROP).
- Permissive hypercapnia did not demonstrate significant benefits in reducing periventricular leukomalacia, ROP, hydrocephalus, or air leaks.
Conclusions:
- There is no established consensus on optimal pCO2 levels in neonates.
- The effectiveness of permissive hypercapnia in neonates is not clearly supported by current data.
- A potential safe pCO2 range of 5-7 kPa (37.5-52.5 mmHg) was inferred, warranting further investigation.
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