기계적 환기요법을 시행받은 미숙아에서 저탄산혈증과 뇌실주위 백질연화증의 발생과의 관계

Abstract

Purpose: To investigate whether hypocarbia during the first 3 days of life plays a role in the development of periventricular leukomalacia (PVL) in preterm infants with mechanical ventilation. Methods: The medical records were reviewed for 19 infants with PVL and 38 with normal neurosonogram who were born before 37 weeks' gestation and who required mechanical ventilation during the first 3 days of life. The patients' characteristics, antenatal and neonatal variables were compared. The CO2 index, TA (time-averaged)-PaCO2, TA-PaO2 and TA-pH were calculated within the first 72 hours of life. The TA-FiO2, TA-respiratory rate (RR), TA-peak inspiratory pressure (PIP), TA-mean airway pressure (MAP) and TA-ventilator index (VI) were also calculated. Results: No significant difference was observed in the clinical characteristics or neonatal variables except hyaline membrane disease (42% in PVL group vs 81% in control group)(P=0.0025). There were no significant differences in CO2 index, TA-PaCO2 and TA- PaO2 between groups. The TA-pH was lower in infants with PVL (7.33±0.06) than in control group (7.37±0.05) (P=0.035). The TA-FiO2, TA-RR, TA-PIP, TA-MAP and TA-VI of two groups showed no significant differences. Conclusion: Partial pressure of arterial carbon dioxide during the first 3 days of life was not associated with the subsequent development of PVL. The compound effects of other risk factors including systemic pH may be important in the development of PVL in preterm infants.