J Korean Soc Neonatol.  2004 May;11(1):6-14.

Brain Injury and Neurodevelopmental Sequelae Following Mechanical Ventilation in Preterm Infants

• Chang YP

Abstract

In the care of neonates, complications from the use of mechanical ventilation and other treatment of respiratory problems have important effects on cardiac output, cerebral blood flow, cerebral oxygenation and cerebral venous return that at times result in brain injury. Hypercapnia or hypocapnia following mechanical ventilation during the first few days of life may result in adverse effect on the CNS in perterm and term infants. Hypocapnia, particularly at PaCO2 levels less than 25 to 30 mmHg, has been associated with periventricular leukomalcia, cerebral palsy and poor neurologic outcomes in preterm infants. Use of smaller tidal volumes combined with permissive hypercapnia to reduce ventilator-induced lung injury may protect against hypocapnia-induced brain injury. Recent randomized clinical studies have demonstrated the safety of mild permissive hypercapnia, but found only small clinical benefits. Several studies have reported that the use of postnatal dexamethasone for severe RDS evolving into BPD have adverse effects on growth and neurodevelopmental outcomes. The results of large long-term follow-up studies strongly suggest an association between use of postnatal dexamethasone and poor neurodevelopmental outcome including cerebral palsy. Further studies including an evaluation of neurodevelopmental outcome as a primary endpoint must be needed for postnatal use of systemic or inhaled steroid.

Keyword

Brain injury; Neurodevelopmental sequelae; Mechanical ventilation; Hypocapnia; Hypercapnia; Postnatal dexamethasone; Newborn; Preterm infant

MeSH Terms

Brain Injuries*
Brain*
Cardiac Output
Cerebral Palsy
Dexamethasone
Follow-Up Studies
Humans
Hypercapnia
Hypocapnia
Infant
Infant, Newborn
Infant, Premature*
Oxygen
Respiration, Artificial*
Tidal Volume
Ventilator-Induced Lung Injury
Dexamethasone
Oxygen