Carboxyhaemoglobin level in neonatal sepsis: A point of care test at paediatric emergency department

Abstract

Carboxyhaemoglobin (COHb) which represents the fraction of carbon monoxide binding to haemoglobin become available as a point-of-care test at the emergency department. Sepsis and other inflammatory process are well-known inducers of heme oxygenase enzymes that cause heme catabolism which results in endogenous carbon monoxide production. Studies have shown that measuring carboxyhaemoglobin level could be of use in early detection of neonatal sepsis. Purpose: This study aims to assesses the rule of COHb as a biomarker for neonatal sepsis in the paediatric emergency department. Methods: This is a retrospective case-control study that looks at the COHb values in neonates presented with febrile illness at paediatric emergency. The neonates were then categorised into culture proven bacterial infections vs culture negative bacterial infections. Different variables were then studied between the two groups. Result: COHb levels were significantly raised at the initial presentation of neonatal sepsis regardless of gender, birth weight, or gestational age. In addition, the COHb value of ≥ 2.05 was highly specific (97.5%) for invasive bacterial infection. Moreover, the mean length of stay regardless of the final diagnosis was significantly higher in the neonate with COHb level ≥2.0 which adds a prognostic value. Conclusion: COHb might be a useful biochemical marker for risk stratification of neonatal sepsis. Further study is needed for better delineation of its clinical utilities.