Abstract
Decreased arterial carbon dioxide tension (PaCO2) results in decreased cerebral blood flow, which is associated with diminished cerebral electrical activity. In such a situation, cerebral fractional oxygen extraction (CFOE) would be expected to increase to preserve cerebral oxygen delivery. This study aimed to determine whether changes in blood gases in infants less than 30 wk' gestation were associated with changes in background electroencephalograms (EEG) and CFOE. Thirty-two very low birth weight infants were studied daily for the first three days after birth. Digital EEG recordings were performed for 75 min each day. CFOE, mean blood pressure and arterial blood gases were measured midway through each recording. EEG was analysed by (a) spectral analysis and (b) manual calculation of interburst interval. Blood pressure, pH and PaCO2 did not have any effect on the EEG. On day one, only PaCO2 showed a relationship with the relative power of the delta frequency band (0.5–3.5 Hz) and the interburst interval. The relative power of the delta band remained within normal limits when PaCO2 was between 24 and 55 mm Hg on day one. There was a negative association between PaCO2 and CFOE. The associations between PaCO2 and EEG measurements were strongest on day one, weaker on day two, and absent on day three. The slowing of EEG and increased CFOE at lower levels of PaCO2 are likely to be due to decreased cerebral oxygen delivery induced by hypocarbia. When PaCO2 was higher, there was suppression of the EEG.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
Abbreviations
- PaCO2:
-
arterial carbon dioxide
- CFOE:
-
cerebral fractional oxygen extraction
- CSvO2:
-
cerebral venous oxygen saturation
- CSaO2:
-
cerebral arterial oxygen saturation
- P90:
-
90th centile
References
Weindling AM, Rochefort MJ, Calvert SA, Fok TF, Wilkinson A 1985 Development of cerebral palsy after ultrasonographic detection of periventricular cysts in the newborn. Dev Med Child Neurol 27: 800–806
Fujimoto S, Togari H, Yamaguchi N, Mizutani F, Suzuki S, Sobajima H 1994 Hypocarbia and cystic periventricular leukomalacia in premature infants. Arch Dis Child 71: F107–F110
Greisen G, Munck H, Lou H 1987 Severe hypocarbia in preterm infants and neurodevelopmental deficit. Acta Paediatr Scand 76: 401–404
Wiswell TE, Graziani LJ, Kornhauser MS, Stanley C, Merton DA, McKee L, Spitzer AR 1996 Effects of hypocarbia on the development of cystic periventricular leukomalacia in premature infants treated with high-frequency jet ventilation. Pediatrics 98: 918–924
Gleason CA, Short BL, Jones MD Jr 1989 Cerebral blood flow and metabolism during and after prolonged hypocapnia in newborn lambs. J Pediatr 115: 309–314
Rosenberg AA 1992 Response of the cerebral circulation to hypocarbia in postasphyxia newborn lambs. Pediatr Res 32: 537–541
Whitelaw A, Karlsson BR, Haaland K, Dahlin I, Steen PA, Thoresen M 1991 Hypocapnia and cerebral ischaemia in hypotensive newborn piglets. Arch Dis Child 66: 1110–1114
Wardle SP, Yoxall CW, Weindling AM 2000 Determinants of cerebral fractional oxygen extraction using near infrared spectroscopy in preterm neonates. J Cereb Blood Flow Metab 20: 272–279
Greisen G, Pryds O 1989 Low CBF, discontinuous EEG activity, and periventricular brain injury in ill, preterm neonates. Brain Dev 11: 164–168
Scher MS 1999 Electroencephalography of the newborn: normal and abnormal features. In: Niedermeyer E, Da Silva FL (eds) Electroencephalography: Basic Principles, Clinical Applications, and Related Fields. Williams and Wilkins, Baltimore, pp 896–946
Benda GI, Engel RC, Zhang YP 1989 Prolonged inactive phases during the discontinuous pattern of prematurity in the electroencephalogram of very-low-birthweight infants. Electroencephalogr Clin Neurophysiol 72: 189–197
Marret S, Parain D, Menard JF, Blanc T, Devaux AM, Ensel P, Fessard C, Samson-Dollfus D 1997 Prognostic value of neonatal electroencephalography in premature newborns less than 33 weeks of gestational age. Electroencephalogr Clin Neurophysiol 102: 178–185
Victor S, Appleton RE, Beirne M, Marson AG, Weindling AM Spectral analysis of electroencephalography in premature newborn infants: normal ranges. Pediatr Res (In press)
Watanabe K, Iwase K, Hara K 1973 Heart rate variability during sleep and wakefulness in low-birthweight infants. Biol Neonate 22: 87–98
Parmelee AH Jr, Wenner WH, Akiyama Y, Schultz M, Stern E 1967 Sleep states in premature infants. Dev Med Child Neurol 9: 70–77
Jasper HH 1958 The Ten - Twenty electrode system of the international federation. Electroencephalogr Clin Neurophysiol 10: 371–375
Biagioni E, Bartalena L, Biver P, Pieri R, Cioni G 1996 Electroencephalographic dysmaturity in preterm infants: a prognostic tool in the early postnatal period. Neuropediatrics 27: 311–316
Yoxall CW, Weindling AM, Dawani NH, Peart I 1995 Measurement of cerebral venous oxyhemoglobin saturation in children by near-infrared spectroscopy and partial jugular venous occlusion. Pediatr Res 38: 319–323
Bland JM, Altman DG 1986 Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1: 307–310
Muizelaar JP, van der Poel HG, Li ZC, Kontos HA, Levasseur JE 1988 Pial arteriolar vessel diameter and CO2 reactivity during prolonged hyperventilation in the rabbit. J Neurosurg 69: 923–927
Sadoshima S, Fujishima M, Tamaki K, Nakatomi Y, Ishitsuka T, Ogata J, Omae T 1980 Response of cortical and pial arteries to changes in arterial CO2 tension in rats-a morphometric study. Brain Res 189: 115–120
Bohr C, Hasselbach K, Krog A 1904 Über einer in biologischer Beziehung wichtigen Einfluss, den die Kohlensäurespannung des Blutes auf dessen Sauerstoffbindung übt. Skand Arch Physiol 16: 402–412
Roberton N 1969 Effect of acute hypoxia on blood pressure and electroencephalogram of newborn babies. Arch Dis Child 44: 719–725
Takahashi T 1999 Activation methods. In: Niedermeyer E, Da Silva FL (eds) Electroencephalography: Basic Principles, Clinical Applications, and Related Fields. Williams and Wilkins, Baltimore, 261–284
Yamatani M, Konishi T, Murakami M, Okuda T 1995 Hyperventilation activation on EEG recording in children with epilepsy. Pediatr Neurol 13: 42–45
Gotoh F, Meyer JS, Takagi Y 1965 Cerebral effects of hyperventilation in man. Arch Neurol 12: 410–423
Hoshi Y, Okuhara H, Nakane S, Hayakawa K, Kobayashi N, Kajii N 1999 Re-evaluation of the hypoxia theory as the mechanism of hyperventilation-induced EEG slowing. Pediatr Neurol 21: 638–643
Greisen G, Trojaborg W 1987 Cerebral blood flow, PaCO2 changes, and visual evoked potentials in mechanically ventilated, preterm infants. Acta Pediatr Scand 76: 394–400
Atkinson J, Anker S, Rae S, Weeks F, Braddick O, Rennie J 2002 Cortical visual evoked potentials in very low birth weight premature infants. Arch Dis Child Fetal Neonatal Ed 86: F28–F31
Kissack CM, Garr R, Wardle SP, Weindling AM 2004 Cerebral fractional oxygen extraction in very low birth weight infants is high when there is low left ventricular output and hypocarbia but is unaffected by hypotension. Pediatr Res 55: 400–405
Rosenberg AA 1988 Response of the cerebral circulation to profound hypocarbia in neonatal lambs. Stroke 19: 1365–1370
Ichord RN, Kirsch JR, Koehler RC, Traytsman RJ 1999 Cerebral anoxia: Experimental view. In: Niedermeyer E, Da Silva FL (eds) Electroencephalography: Basic Principles, Clinical Applications, and Related Fields. Williams and Wilkins, Baltimore, 432–444
Watanabe K, Hayakawa F, Okumura A 1999 Neonatal EEG: a powerful tool in the assessment of brain damage in preterm infants. Brain Dev 21: 361–372
Stein SN, Pollock GH 1949 Central inhibitory effects of carbon dioxide II. Proc Soc Exp Biol Med 70: 290–291
Pollock GH, Stein SN, Gyarfas K 1949 Central inhibitory effects of carbon dioxide III. Proc Soc Exp Biol Med 70: 291–292
Caspers H, Speckmann EJ, Lehmenkuhler A 1979 Effects of carbon dioxide on cortical field potentials in relation to neuronal activity. In: Speckmann EJ, Caspers H (eds) Origin of Cerebral Potentials. Thieme, Stuttgart, 151–163
Parfenova H, Shibata M, Zuckerman S, Leffler CW 1994 CO2 and cerebral circulation in newborn pigs: cyclic nucleotides and prostanoids in vasculr regulation. Am J Physiol 266: H1494–H1501
Leahy FA, Cates D, MacCallum M, Rigatto H 1980 Effect of CO2 and 100% O2 on cerebral blood flow in preterm infants. J Appl Physiol 48: 468–472
Pryds O, Greisen G, Skov LL, Friis-Hansen B 1990 Carbon dioxide-related changes in cerebral blood volume and cerebral blood flow in mechanically ventilated preterm neonates: comparison of near infrared spectrophotometry and 133Xenon clearance. Pediatr Res 27: 445–449
Hino JK, Short BL, Rais-Bahrami K, Seale WR 2000 Cerebral blood flow and metabolism during and after prolonged hypercapnia in newborn lambs. Crit Care Med 28: 3505–3510
Eaton DG, Wertheim D, Oozeer R, Dubowitz LM, Dubowitz V 1994 Reversible changes in cerebral electrical activity associated with acidosis in preterm neonates. Acta Pediatr 83: 486–492
Wyke BD, Graham GR, Hill DW, Nunn JF 1963 Neurophysiological aspects of narcosis produced by inhalation of very high concentrations of carbon dioxide. I Changes in cerebral electrical activity. In: Wyke BD (ed) Brain Function and Metabolic Disorders. Butterworth, London, 161–163
Evans N, Kluckow M 1996 Early determinants of right and left ventricular output in ventilated preterm infants. Arch Dis Child Fetal Neonatal Ed 74: F88–F94
Cunningham S, Symon AG, Elton RA, Zhu C, McIntosh N 1999 Intra-arterial blood pressure reference ranges, death and morbidity in very low birthweight infants during the first seven days of life. Early Hum Dev 56: 151–165
Meek JH, Tyszczuk L, Elwell CE, Wyatt JS 1998 Cerebral blood flow increases over the first three days of life in extremely preterm neonates. Arch Dis Child Fetal Neonatal Ed 78: F33–F37
Pryds O, Greisen G, Lou H, Friis-Hansen G 1989 Heterogeneity of cerebral vasoreactivity in preterm infants supported by mechanical ventilation. J Pediatr 115: 638–645
Levene MI, Shortland D, Gibson N, Evans DH 1988 Carbon dioxide reactivity of the cerebral circulation in extremely premature infants: effects of postnatal age and indomethacin. Pediatr Res 24: 175–179
Fenton AC, Woods KL, Evans DH, Levene MI 1992 Cerebrovascular carbon dioxide reactivity and failure of autoregulation in preterm infants. Arch Dis Child 67: 835–839
Koehler RC, Traystman RJ 1982 Bicarbonate ion modulation of cerebral blood flow during hypoxia and hypercapnia. Am J Physiol 243: H33–H40
Kontos HA, Raper AJ, Patterson JL 1977 Analysis of vasoactivity of local pH, PaCO2 and bicarbonate on pial vessels. Stroke 8: 358–360
Wagerle LC, Kumar SP, Belik J, Delivoria-Papadopoulos M 1988 Blood-brain barrier to hydrogen ion during acute metabolic acidosis in piglets. J Appl Physiol 65: 776–781
Author information
Authors and Affiliations
Corresponding author
Additional information
This work was supported by the Newborn Appeal.
Rights and permissions
About this article
Cite this article
Victor, S., Appleton, R., Beirne, M. et al. Effect of carbon dioxide on background cerebral electrical activity and fractional oxygen extraction in very low birth weight infants just after birth. Pediatr Res 58, 579–585 (2005). https://doi.org/10.1203/01.pdr.0000169402.13435.09
Received:
Accepted:
Issue date:
DOI: https://doi.org/10.1203/01.pdr.0000169402.13435.09
This article is cited by
-
Neuromonitoring in neonatal critical care part II: extremely premature infants and critically ill neonates
Pediatric Research (2023)
-
Antecedents of epilepsy and seizures among children born at extremely low gestational age
Journal of Perinatology (2019)
-
EEG maturation and stability of cerebral oxygen extraction in very low birth weight infants
Journal of Perinatology (2016)
-
Effect of permissive hypercapnia on background cerebral electrical activity in premature babies
Pediatric Research (2014)
