Hypercapnia Causes Injury of the Cerebral Cortex and Cognitive Deficits in Newborn Piglets.

In critically ill newborns, exposure to hypercapnia (HC) is common and often accepted in neonatal intensive care units to prevent severe lung injury. However, as a "safe" range of arterial partial pressure of carbon dioxide levels in neonates has not been established, the potential impact of HC on the neurodevelopmental outcomes in these newborns remains a matter of concern. Here, in a newborn Yorkshire piglet model of either sex, we show that acute exposure to HC induced persistent cortical neuronal injury, associated cognitive and learning deficits, and long-term suppression of cortical electroencephalogram frequencies. HC induced a transient energy failure in cortical neurons, a persistent dysregulation of calcium-dependent proapoptotic signaling in the cerebral cortex, and activation of the apoptotic cascade, leading to nuclear deoxyribonucleic acid fragmentation. While neither 1 h of HC nor the rapid normalization of HC was associated with changes in cortical bioenergetics, rapid resuscitation resulted in a delayed onset of synaptosomal membrane lipid peroxidation, suggesting a dissociation between energy failure and the occurrence of synaptosomal lipid peroxidation. Even short durations of HC triggered biochemical responses at the subcellular level of the cortical neurons resulting in altered cortical activity and impaired neurobehavior. The deleterious effects of HC on the developing brain should be carefully considered as crucial elements of clinical decisions in the neonatal intensive care unit.

Timing and Associated Outcomes of Chemical Prophylaxis Against Venous Thromboembolism in the Elderly Trauma Population.

This study aims to assess chemical VTE prophylactic type and timing and associated outcomes within the elderly trauma population. This is a single center study of Trauma Registry data, inclusive years July 1, 2016, to February 28, 2021. The patients were grouped based upon discharge disposition. 7261 elderly trauma patients were included in the analysis. Late administration of VTE prophylaxis was associated with a discharge disposition to hospice. Administration of unfractionated heparin was most associated with in-hospital mortality. Xa inhibitors had the least impact on morbidity and mortality, with most likely associations in discharge to rehab or a skilled nursing facility. LMWH associated with a discharge to a rehab facility. The timing of administration and type of VTE prophylaxis may significantly affect the morbidity and mortality outcomes in elderly trauma.