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Carbon Dioxide and Glucose Affect Electrocortical Background in Extremely Preterm Infants

Wikstrom, Sverre; Lundin, Fredrik; Ley, David LU ; Pupp, Ingrid LU ; Fellman, Vineta LU ; Rosén, Ingmar LU and Hellstrom-Westas, Lena (2011) In Pediatrics 127(4). p.1028-1034
Abstract
OBJECTIVES: To investigate if PaCO2 and plasma glucose levels affect electrocortical activity. METHODS: Ours was an observational study of 32 infants with a gestational age of 22 to 27 weeks. We performed simultaneous single-channel electroencephalogram (EEG) and repeated blood gas/plasma glucose analyses during the first 3 days (n = 247 blood samples with corresponding EEG). Interburst intervals (IBIs) and EEG power were averaged at the time of each blood sample. RESULTS: There was a linear relationship between PaCO2 and IBI; increasing PaCO2 was associated with longer IBIs. One day after birth, a 1-kPa increase in PaCO2 was associated with a 16% increase in IBI in infants who survived the first week without severe brain injury. EEG power... (More)
OBJECTIVES: To investigate if PaCO2 and plasma glucose levels affect electrocortical activity. METHODS: Ours was an observational study of 32 infants with a gestational age of 22 to 27 weeks. We performed simultaneous single-channel electroencephalogram (EEG) and repeated blood gas/plasma glucose analyses during the first 3 days (n = 247 blood samples with corresponding EEG). Interburst intervals (IBIs) and EEG power were averaged at the time of each blood sample. RESULTS: There was a linear relationship between PaCO2 and IBI; increasing PaCO2 was associated with longer IBIs. One day after birth, a 1-kPa increase in PaCO2 was associated with a 16% increase in IBI in infants who survived the first week without severe brain injury. EEG power was highest at a PaCO2 value of 5.1 kPa and was attenuated both at higher and lower PaCO2 values. Corrected for carbon dioxide effects, plasma glucose was also associated with IBI. Lowest IBI appeared at a plasma glucose level of 4.0 mmol/L, and there was a U-shaped relationship between plasma glucose level and EEG with increasing discontinuity at glucose concentrations above and below 4.0 mmol/L. CONCLUSIONS: Both carbon dioxide and plasma glucose level influenced EEG activity in extremely preterm infants, and values considered to be within normal physiologic ranges were associated with the best EEG background. Increasing EEG discontinuity occurred at carbon dioxide levels frequently applied in lung-protection strategies; in addition, moderate hyperglycemia was associated with measurable EEG changes. The long-term effects of changes in carbon dioxide and glucose on brain function are not known. Pediatrics 2011; 127: e1028-e1034 (Less)
Please use this url to cite or link to this publication:
author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
hypercapnia, hypoglycemia, hyperglycemia, electrocortical activity
in
Pediatrics
volume
127
issue
4
pages
1028 - 1034
publisher
American Academy of Pediatrics
external identifiers
  • wos:000289074800023
  • scopus:79953322034
ISSN
1098-4275
DOI
10.1542/peds.2010-2755
language
English
LU publication?
yes
id
5d464909-f1c2-4c74-b002-251fd1167216 (old id 1918337)
date added to LUP
2011-05-03 07:24:18
date last changed
2017-10-22 04:26:03
@article{5d464909-f1c2-4c74-b002-251fd1167216,
  abstract     = {OBJECTIVES: To investigate if PaCO2 and plasma glucose levels affect electrocortical activity. METHODS: Ours was an observational study of 32 infants with a gestational age of 22 to 27 weeks. We performed simultaneous single-channel electroencephalogram (EEG) and repeated blood gas/plasma glucose analyses during the first 3 days (n = 247 blood samples with corresponding EEG). Interburst intervals (IBIs) and EEG power were averaged at the time of each blood sample. RESULTS: There was a linear relationship between PaCO2 and IBI; increasing PaCO2 was associated with longer IBIs. One day after birth, a 1-kPa increase in PaCO2 was associated with a 16% increase in IBI in infants who survived the first week without severe brain injury. EEG power was highest at a PaCO2 value of 5.1 kPa and was attenuated both at higher and lower PaCO2 values. Corrected for carbon dioxide effects, plasma glucose was also associated with IBI. Lowest IBI appeared at a plasma glucose level of 4.0 mmol/L, and there was a U-shaped relationship between plasma glucose level and EEG with increasing discontinuity at glucose concentrations above and below 4.0 mmol/L. CONCLUSIONS: Both carbon dioxide and plasma glucose level influenced EEG activity in extremely preterm infants, and values considered to be within normal physiologic ranges were associated with the best EEG background. Increasing EEG discontinuity occurred at carbon dioxide levels frequently applied in lung-protection strategies; in addition, moderate hyperglycemia was associated with measurable EEG changes. The long-term effects of changes in carbon dioxide and glucose on brain function are not known. Pediatrics 2011; 127: e1028-e1034},
  author       = {Wikstrom, Sverre and Lundin, Fredrik and Ley, David and Pupp, Ingrid and Fellman, Vineta and Rosén, Ingmar and Hellstrom-Westas, Lena},
  issn         = {1098-4275},
  keyword      = {hypercapnia,hypoglycemia,hyperglycemia,electrocortical activity},
  language     = {eng},
  number       = {4},
  pages        = {1028--1034},
  publisher    = {American Academy of Pediatrics},
  series       = {Pediatrics},
  title        = {Carbon Dioxide and Glucose Affect Electrocortical Background in Extremely Preterm Infants},
  url          = {http://dx.doi.org/10.1542/peds.2010-2755},
  volume       = {127},
  year         = {2011},
}