Mechanical Ventilation, Partial Pressure of Carbon Dioxide, Increased Fraction of Inspired Oxygen and the Increased Risk for Adverse Short-Term Outcomes in Cooled Asphyxiated Newborns

• Main Authors: Stamatios Giannakis, Maria Ruhfus, Mona Markus, Anja Stein, Thomas Hoehn, Ursula Felderhoff-Mueser, Hemmen Sabir
• Format: Article
• Language: English
• Published: MDPI AG 2021-05-01
• Series: Children
• Subjects: perinatal asphyxia; hypoxic–ischemic encephalopathy; therapeutic hypothermia; outcome; hypocapnia; hyperoxia
• Online Access: https://www.mdpi.com/2227-9067/8/6/430

Neonates treated with therapeutic hypothermia (TH) following perinatal asphyxia (PA) suffer a considerable rate of disability and mortality. Several risk factors associated with adverse outcomes have been identified. Mechanical ventilation might increase the risk for hyperoxia and hypocapnia in cooled newborns. We carried out a retrospective study in 71 asphyxiated cooled newborns. We analyzed the association of ventilation status and adverse short-term outcomes and investigated the effect of the former on pCO₂ and oxygen delivery before, during and after TH. Death, abnormal findings on magnetic resonance imaging, and pathological amplitude-integrated electroencephalography traces were used to define short-term outcomes. The need for mechanical ventilation was significantly higher in the newborns with adverse outcomes (38% vs. 5.6%, <i>p</i> = 0.001). Compared to spontaneously breathing neonates, intubated newborns suffered from significantly more severe asphyxia, had significantly lower levels of mean minimum pCO₂ over the first 6 and 72 h of life (HOL) (<i>p</i> = 0.03 and <i>p</i> = 0.01, respectively) and increased supply of inspired oxygen, which was, in turn, significantly higher in the newborns with adverse outcomes (<i>p</i> < 0.01). Intubated newborns with adverse short-term outcomes had lower levels of pCO₂ over the first 36 HOL. In conclusion, need for mechanical ventilation was significantly higher in newborns with more severe asphyxia. In ventilated newborns, level of encephalopathy, lower pCO₂ levels, and increased oxygen supplementation were significantly higher in the adverse short-term outcomes group. Ventilatory parameters need to be carefully monitored in cooled asphyxiated newborns.