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QUESTION 1 Is permissive hypercapnia beneficial to preterm infants?
  1. Murwan Omer1,
  2. Eleanor J Molloy2
  1. 1Department of Paediatrics, Coombe Women and Infants University Hospital, Dublin, Ireland
  2. 2Department of Neonatology, Our lady's Children's Hospital, Trinity College, the University of Dublin, Dublin, Ireland
  1. Correspondence to Professor Eleanor Molloy, Consultant Neonatologist & Paediatrician, Discipline of Paediatrics and Child Health, Academic Centre, Tallaght Hospital, Dublin 24, Ireland; Eleanor.molloy{at}tcd.ie

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Scenario

A preterm baby girl born at 25 weeks gestation is 1 week old and remains intubated and ventilated. During the ward round, the consultant discusses the ideal target range of pCO2 and the specialist registrar asks about the use of permissive hypercapnia (PHC).

Structured clinical question

In a preterm infant on respiratory support (patient), what is the optimal pCO2 to prevent (intervention) chronic lung disease and periventricular leukomalacia (outcome)?

Search strategy

PubMed database was searched in July 2016 for the following terms: ‘carbon dioxide’ AND ‘Infants’ AND ‘hypercapnia’. The search returned 292 abstracts, 26 were relevant and appropriate for further review. A search of the Cochrane Library using the search terms ‘carbon dioxide’ AND ‘Infants' AND ‘hypercapnia’ was used yielding one result.

Commentary

Carbon dioxide (CO2) is a by-product of aerobic breathing; it is carried and dissolved in blood and bound to haemoglobin and plasma proteins. The arterial carbon dioxide level (pCO2) represents the balance between CO2 production and elimination.1 Avery et al2 hypothesised that tolerance of pCO2 above the physiological range may …

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