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Early Postnatal Hypocapnia and Hypercapnia in Ventilated Preterm Infants: Incidence and Associations with Adverse

Ilias Chatziioannidis1, Angeliki Kontou1, Eleni Agakidou1

  • 11st Department of Neonatology and Neonatal Intensive Care, Faculty of Medicine, School of Health Sciences, Ippokrateion General Hospital, Aristotle University of Thessaloniki, Kostantinoupoleos 49 Str., 54642 Thessaloniki, Greece.

Journal of Personalized Medicine
|April 27, 2026
PubMed

Insights

Carbon dioxide (CO2) instability is common in preterm infants on ventilators, linked to poor outcomes. Extreme prematurity is a key risk factor for adverse events, while high CO2 levels predict bronchopulmonary dysplasia.

Area of Science:

  • Neonatology
  • Pediatric Critical Care
  • Respiratory Physiology

Background:

  • Abnormal partial pressure of carbon dioxide (PCO2) during respiratory support is linked to adverse neonatal outcomes.
  • Understanding early PCO2 fluctuations is crucial for managing mechanically ventilated preterm infants.

Purpose of the Study:

  • To determine the incidence of early hypocapnia and hypercapnia in mechanically ventilated preterm infants.
  • To identify major associated outcomes, including death, severe brain injury (SBI), and bronchopulmonary dysplasia (BPD).

Main Methods:

  • Retrospective cohort study of preterm infants (< 32 weeks gestation) requiring invasive ventilation (> 24 hours).
  • Analysis of blood gas values (arterial and capillary-venous) within the first 72 hours of life.
  • Evaluation of PCO2 levels (normocapnia: 35-45 mmHg, hypocapnia: < 35 mmHg, hypercapnia: > 45 mmHg) and secondary outcomes via logistic regression.

Main Results:

  • High incidence of PCO2 abnormalities: hypercapnia (81.3%) and hypocapnia (93.2%) were prevalent.
  • Significant adverse outcomes: death or SBI (51.5%), SBI alone (42.5%).
  • Independent predictors of death/SBI: gestational age < 28 weeks, air-leak syndromes, pulmonary hemorrhage. Hypercapnia and prematurity predicted BPD in survivors.

Conclusions:

  • PCO2 instability is highly prevalent in ventilated preterm infants, necessitating individualized ventilation strategies.
  • Extreme prematurity (< 28 weeks gestation) is the primary risk factor for adverse outcomes.
  • Hypercapnia is an independent predictor of BPD among survivors.

Keywords:
carbon dioxidemechanical ventilationneonatepersonalized medicine

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