@article {ThomeF376, author = {Ulrich H Thome and Orsolya Genzel-Boroviczeny and Bettina Bohnhorst and Manuel Schmid and Hans Fuchs and Oliver Rohde and Stefan Avenarius and Hans-Georg Topf and Andrea Zimmermann and Dirk Faas and Katharina Timme and Barbara Kleinlein and Horst Buxmann and Wilfried Schenk and Hugo Segerer and Norbert Teig and Annett Bl{\"a}ser and Roland Hentschel and Matthias Heckmann and Rolf Schl{\"o}sser and Jochen Peters and Rainer Rossi and Wolfgang Rascher and Ralf B{\"o}ttger and J{\"u}rgen Seidenberg and Gesine Hansen and Maria Zernickel and Harald Bode and Jens Dreyhaupt and Rainer Muche and Helmut D Hummler}, editor = {,}, title = {Neurodevelopmental outcomes of extremely low birthweight infants randomised to different PCO2 targets: the PHELBI follow-up study}, volume = {102}, number = {5}, pages = {F376--F382}, year = {2017}, doi = {10.1136/archdischild-2016-311581}, publisher = {BMJ Publishing Group}, abstract = {Background Tolerating higher partial pressures of carbon dioxide (PCO2) in mechanically ventilated extremely low birthweight infants to reduce ventilator-induced lung injury may have long-term neurodevelopmental side effects. This study analyses the results of neurodevelopmental follow-up of infants enrolled in a randomised multicentre trial.Methods Infants (n=359) between 400 and 1000 g birth weight and 23 0/7{\textendash}28 6/7 weeks gestational age who required endotracheal intubation and mechanical ventilation within 24 hours of birth were randomly assigned to high PCO2 or to a control group with mildly elevated PCO2 targets. Neurodevelopmental follow-up examinations were available for 85\% of enrolled infants using the Bayley Scales of Infant Development II, the Gross Motor Function Classification System (GMFCS) and the Child Development Inventory (CDI).Results There were no differences in body weight, length and head circumference between the two PCO2 target groups. Median Mental Developmental Index (MDI) values were 82 (60{\textendash}96, high target) and 84 (58{\textendash}96, p=0.79). Psychomotor Developmental Index (PDI) values were 84 (57{\textendash}100) and 84 (65{\textendash}96, p=0.73), respectively. Moreover, there was no difference in the number of infants with MDI or PDI \<70 or \<85 and the number of infants with a combined outcome of death or MDI\<70 and death or PDI\<70. No differences were found between results for GMFCS and CDI. The risk factors for MDI\<70 or PDI\<70 were intracranial haemorrhage, bronchopulmonary dysplasia, periventricular leukomalacia, necrotising enterocolitis and hydrocortisone treatment.Conclusions A higher PCO2 target did not influence neurodevelopmental outcomes in mechanically ventilated extremely preterm infants. Adjusting PCO2 targets to optimise short-term outcomes is a safe option.Trial registration number ISRCTN56143743.}, issn = {1359-2998}, URL = {https://fn.bmj.com/content/102/5/F376}, eprint = {https://fn.bmj.com/content/102/5/F376.full.pdf}, journal = {Archives of Disease in Childhood - Fetal and Neonatal Edition} }