{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T11:56:34Z","timestamp":1790164594829,"version":"4.1.0"},"reference-count":25,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2025,6,17]],"date-time":"2025-06-17T00:00:00Z","timestamp":1750118400000},"content-version":"vor","delay-in-days":16,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2025,6,1]],"date-time":"2025-06-01T00:00:00Z","timestamp":1748736000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Pulmonology"],"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To determine if targeting higher levels of pH\u2010controlled permissive hypercapnia beyond postnatal day 7\u201314 reduces mechanical ventilation duration in preterm infants.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Single\u2010center randomized clinical trial with a 1:1 parallel allocation including infants from 22\u221236 weeks' gestation mechanically ventilated for respiratory distress syndrome on postnatal day 7\u201314. We targeted higher levels of pH\u2010controlled permissive hypercapnia (60\u201375\u2009mmHg and pH \u2265\u20097.20) or lower levels of pH\u2010controlled permissive hypercapnia (40\u201355\u2009mmHg and pH \u2265\u20097.25) for 28 days after randomization. The primary outcome was the number of days alive and ventilator\u2010free in the 28 days after randomization.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      We enrolled 130 infants with a gestational age (mean\u2009\u00b1\u2009SD) of 24 weeks and 5 days\u2009\u00b1\u20092 weeks and 0 days and birth weight of 657\u2009\u00b1\u2009198 grams from December 2015 to May 2021. Infants randomized to higher levels of pH\u2010controlled permissive hypercapnia had more alive ventilator\u2010free days than infants randomized to lower levels of pH\u2010controlled permissive hypercapnia (11\u2009\u00b1\u200910 vs. 6\u2009\u00b1\u20098;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.009). Grade 2\u20133 bronchopulmonary dysplasia or death before discharge was not significantly lower in the higher carbon dioxide (PCO\n                      <jats:sub>2<\/jats:sub>\n                      ) group (30\/62 (44%) vs. 45\/68 (59%); adjusted odds ratio (aOR) 0.54, 95% confidence intervals (CI) 0.27\u20131.08;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.08). Grade 2\u20133 bronchopulmonary dysplasia among survivors at 36 weeks' postmenstrual age did not differ significantly (higher PCO\n                      <jats:sub>2<\/jats:sub>\n                      19\/53 (35%) vs. lower PCO\n                      <jats:sub>2<\/jats:sub>\n                      28\/53 (50%); aOR 0.56, 95% CI 0.27\u20131.13;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.12).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Targeting higher levels of permissive hypercapnia from postnatal day 7\u201314 increased the number of days alive and ventilator\u2010free and may be lung protective compared with targeting lower levels.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>Clinicaltrials.gov (identifier number NCT02799875). The first infant was enrolled in December 2015 and the trial was not registered until June 2016. The authors confirm that there were no changes made to the Institutional Review Board (IRB) approved trial protocol (dated 10\/20\/2015) or any amendments made after recruitment started, between the date of first enrollment and the date of clinicaltrials.gov registration, or between study commencement and completion. Furthermore, the authors confirm that the data were not unblinded until after the last infant had been enrolled (March 2021) and discharged from the hospital (August 2021). Study Details | Late Permissive Hypercapnia for Intubated and Ventilated Preterm Infants | ClinicalTrials.gov.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ppul.71165","type":"journal-article","created":{"date-parts":[[2025,6,17]],"date-time":"2025-06-17T08:37:56Z","timestamp":1750149476000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Late Permissive Hypercapnia for Mechanically Ventilated Preterm Infants: A Randomized Trial"],"prefix":"10.1002","volume":"60","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3218-1024","authenticated-orcid":false,"given":"Colm P.","family":"Travers","sequence":"first","affiliation":[{"name":"Department of Pediatrics University of Alabama at Birmingham Birmingham Alabama USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0238-6472","authenticated-orcid":false,"given":"Samuel J.","family":"Gentle","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University of Alabama at Birmingham Birmingham Alabama USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vivek V.","family":"Shukla","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University of Alabama at Birmingham Birmingham Alabama USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Inmaculada","family":"Aban","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University of Alabama at Birmingham Birmingham Alabama USA"},{"name":"Department of Biostatistics University of Alabama at Birmingham Birmingham Alabama USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aaron J.","family":"Yee","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Nemours Alfred I. duPont Hospital for Children Wilmington Delaware USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimberly M.","family":"Armstead","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University of Alabama at Birmingham Birmingham Alabama USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel L.","family":"Benz","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University of Alabama at Birmingham Birmingham Alabama USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deborah","family":"Laney","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University of Alabama at Birmingham Birmingham Alabama USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0731-9092","authenticated-orcid":false,"given":"Namasivayam","family":"Ambalavanan","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University of Alabama at Birmingham Birmingham Alabama USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Waldemar A.","family":"Carlo","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University of Alabama at Birmingham Birmingham Alabama USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,6,17]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2021.23580"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1700827"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2023-064153"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-2600(18)30530-7"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201412-2142PP"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1513\/AnnalsATS.201312-424LD"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2005.01.047"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2021.21892"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD000510.pub2"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.202210-1971OC"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1136\/archdischild-2012-302649"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.siny.2008.08.005"},{"key":"e_1_2_11_14_1","first-page":"1970","volume-title":"New England Journal of Medicine","author":"Finer N. 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