Improvement Initiative: End-Tidal Carbon Monoxide Measurement in Newborns Receiving Phototherapy

Bahr, Timothy M.; Shakib, Julie H.; Stipelman, Carole H.; Kawamoto, Kensaku; Lauer, Sarah; Christensen, Robert D.

doi:10.1016/j.jpeds.2021.07.008

Cited by 10 publications

(4 citation statements)

References 24 publications

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“…Bahr et al measured the ETCO value of hospitalized newborns with hyperbilirubinemia and found that for every 1ppm increase in ETCO, phototherapy was advanced by 9 hours and the duration of phototherapy increased by 9.3 hours (n = 170). 15 Zhan et al found that hospitalized patients with hyperbilirubinemia who received phototherapy for > 72 hours had higher ETCOc than those < 72 hours (2.45 vs. 1.60 ppm, P = 0.001). 16 Javier MC et al found that there was an almost linear correlation (r = 0.86) between the RET and the ETCOc among Coombs' test-positive infants.…”

Section: Discussionmentioning

confidence: 99%

Predictive value of end-tidal carbon monoxide concentration (ETCOc) within 48 hours after birth in neonatal hyperbilirubinemia caused by hemolysis.

Yang,

Cheng,

Lin

et al. 2024

Preprint

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OBJECTIVES: To investigate the predictive value of end-tidal carbon monoxide concentration (ETCOc) within 48 hours after birth in neonatal hyperbilirubinemia caused by hemolysis. METHODS: A prospective study was conducted on hemolytic high-risk newborns. ETCOc within 24 hours (D1-ETCO) and between 24 to 48 hours after birth (D2-ETCO) were measured. They were divided into a normal group, a nonhemolytic hyperbilirubinemia (NHH) group, and a hemolytic group based on whether they had hyperbilirubinemia or hemolysis. RESULTS: The hemolytic group had the highest ETCOc values, followed by the NHH group, and the normal group. The AUC of D1-ETCO and D2-ETCO were 0.958 and 0.862. The sensitivity and specificity were 83.3%, 94.7%, 72.0%, and 96.0%, respectively. There was a linear correlation between D1-ETCO and total bilirubin /age at admission ratio and reticulocytes (r = 0.896 and 0.878, respectively). CONCLUSIONS: ETCOc within 48 hours can predict hyperbilirubinemia caused by hemolysis well.

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Section: Discussionmentioning

confidence: 99%

Predictive value of end-tidal carbon monoxide concentration (ETCOc) within 48 hours after birth in neonatal hyperbilirubinemia caused by hemolysis.

Yang,

Cheng,

Lin

et al. 2024

Preprint

View full text Add to dashboard Cite

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“…Most current studies use early ETCOc values to predict the occurrence of subsequent hyperbilirubinemia ( 3 , 12 , 20 ) or to evaluate the relationship between ETCOc and hemolytic diseases ( 4 , 5 , 17 ). A 2021 study ( 21 ) tried to explore the relationship between ETCOc levels and the duration of phototherapy in infants with hyperbilirubinemia, including the time of phototherapy initiation as well as the number and duration of phototherapy courses; and the study mainly focused on the observation of normal newborns and only a small part of neonates who needed phototherapy with lower STB (mean 239.4 µmol/L). Our study included infants with significant hyperbilirubinemia and STB that required phototherapy for the given age and risk category (mean 327.0 µmol/L) and admission to the neonatal department for intense phototherapy.…”

Section: Discussionmentioning

confidence: 99%

Higher ETCOc predicts longer phototherapy treatment in neonatal hyperbilirubinemia

et al. 2023

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ObjectiveThis study aimed to evaluate the predictive performance of end-tidal carbon monoxide corrected to ambient carbon monoxide (ETCOc) values phototherapy in neonates with significant hyperbilirubinemia.MethodsA prospective study was conducted on neonates with significant hyperbilirubinemia who received phototherapy between 3 and 7 days of life. The breath ETCOc and serum total bilirubin of the recruited infants were measured on admission.ResultsThe mean ETCOc at admission in 103 neonates with significant hyperbilirubinemia was 1.70 ppm. The neonates were categorized into two groups: phototherapy duration ≤72 h (n = 87) and >72 h (n = 16) groups. Infants who received phototherapy for >72 h had significantly higher ETCOc (2.45 vs. 1.60, P = 0.001). The cutoff value of ETCOc on admission for predicting longer phototherapy duration was 2.4 ppm, with a sensitivity of 62.5% and specificity of 88.5%, yielding a 50% positive predictive value and a 92.7% negative predictive value.ConclusionETCOc on admission can help predict the duration of phototherapy in neonates with hyperbilirubinemia, facilitate clinicians to judge disease severity, and make clinical communication easier and more efficient.

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“…Previous authors recommended the clinical implementation of ETCO to quantify hemolysis, 13,21,31 and these recommendations were followed by many neonatal units 32,33 . Despite being the most studied marker of hemolysis and possessing advantages over other markers, CO elimination testing has not been widely accepted as a standard measurement of hemolysis in most clinical settings and patient demographics.…”

Section: What Are Its Limitations and Pitfalls?mentioning

confidence: 99%

“…Research laboratory methods can overcome these limitations, but are rarely used outside of experimental settings 25 . The use of CO as a hemolysis marker appears to show wider penetration in pediatric clinical settings compared to adult populations, 32–34 which may reflect more active clinical research to test and diagnose genetic hemolytic conditions in neonates and children compared to acquired causes in adult populations.…”

Section: What Are Its Limitations and Pitfalls?mentioning

confidence: 99%

Carbon monoxide as a clinical marker of hemolysis

2023

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Carbon monoxide (CO)-based tests have precisely measured hemolysis for over 40 years. End-tidal CO was the primary marker in clinical hematology research, followed by carboxyhemoglobin. Quantification of CO reflects heme oxygenases degrading heme in a 1:1 stoichiometric ratio, making CO a direct marker of hemolysis. CO in alveolar air can be quantified using gas chromatography, whose high resolution allows detecting mild and moderate levels of hemolysis. CO can be elevated in active bleeding, resorbing hematoma, and smoking. Clinical acumen and other markers remain necessary to diagnose the cause of hemolysis. CO-based tests constitute an opportunity for bench-to-bedside technology transfer.

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Improvement Initiative: End-Tidal Carbon Monoxide Measurement in Newborns Receiving Phototherapy

Cited by 10 publications

References 24 publications

Predictive value of end-tidal carbon monoxide concentration (ETCOc) within 48 hours after birth in neonatal hyperbilirubinemia caused by hemolysis.

Predictive value of end-tidal carbon monoxide concentration (ETCOc) within 48 hours after birth in neonatal hyperbilirubinemia caused by hemolysis.

Higher ETCOc predicts longer phototherapy treatment in neonatal hyperbilirubinemia

Carbon monoxide as a clinical marker of hemolysis

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