Influence of Respiratory Acidosis and Blood Glucose on Cerebral Activity of Premature Infants

Fluctuations of physiologic parameters in extremely preterm infants may significantly affect their cerebral activity. This study assessed the correlation between blood gas indices and other clinical parameters with cerebral activity, as recorded by amplitude integrated electroencephalography in the first three days of life of a prospective cohort study of infants born at <28 weeks gestation. Amplitude integrated electroencephalography was assessed according to a nine-grade pattern scale. For univariate analysis, the Spearman rank coefficient, Student t test, and χ(2) test were used. For multivariate analysis, generalized estimating equations were used. Overall, 255 blood samples from 24 recruited infants were analyzed. The pattern scale demonstrated a significant positive correlation with pH (ρ = 0.45, P < 0.0001) and base excess (ρ = 0.37, P < 0.0001), and a significant negative correlation with partial pressure of carbon dioxide (pCO(2)) (ρ = -0.35, P < 0.0001) and blood dextrose (ρ = -0.36, P < 0.0001). When amplitude integrated electroencephalography was used as dependent variable, the best generalized estimating equation models yielded significant correlations for pH, pCO(2), and HCO(3)(-). When pH was used as dependent variable, the best models yielded significant correlations for amplitude integrated electroencephalography pattern scale and blood dextrose. We suggest that depression in cerebral function early in life should prompt clinicians to assess acid/base status and respiratory parameters of the extremely premature infant as well as other known causes of cerebral depression.