Transcutaneous carbon dioxide monitoring for the prevention of neonatal morbidity and mortality

Bruschettini, Matteo; Romantsik, Olga; Zappettini, Simona; Ramenghi, Luca A.; Calevo, Maria Grazia

doi:10.1002/14651858.cd011494.pub2

Cited by 16 publications

(13 citation statements)

References 51 publications

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“…In fact, evidence clearly shows that pCO 2 strongly influences cerebral perfusion in newborn infants, especially in those of low gestational age (6), and its uncontrolled increase may lead to brain injury. Moreover, the fact that blood gas values change quite rapidly has raised interest for continuous monitoring of pCO 2 (7). Therefore, invasive and non-invasive pCO 2 monitoring is widely used in neonates admitted to neonatal intensive care units (NICU).…”

Section: Discussionmentioning

confidence: 99%

Feasibilty of Transcutaneous pCO2 Monitoring During Immediate Transition After Birth—A Prospective Observational Study

et al. 2020

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Background: According to recommendations, non-invasive monitoring during neonatal resuscitation after birth includes heart rate (HR) and oxygen saturation (SpO 2). Continuous transcutaneous monitoring of carbon dioxide partial pressure (tcpCO 2) may further offer quantitative information on neonatal respiratory status. Objective: We aimed to investigate feasibility of tcpCO 2 measurements in the delivery room during immediate neonatal transition and to compare the course of tcpCO 2 between stable term and preterm infants. Methods: Neonates without need for cardio-respiratory intervention during immediate transition after birth were enrolled in a prospective observational study. In these term and preterm neonates, we measured HR and SpO 2 by pulse oximetry on the right wrist and tcpCO 2 with the sensor applied on the left hemithorax during the first 15 min after birth. Courses of tcpCO 2 were analyzed in term and preterm neonates and groups were compared. Results: Fifty-three term (gestational age: 38.8 ± 0.9 weeks) and 13 preterm neonates (gestational age: 34.1 ± 1.5 weeks) were included. First tcpCO 2 values were achieved in both groups at minute 4 after birth, which reached a stable plateau after the equilibration phase at minute 9. Mean tcpCO 2 values 15 min after birth were 46.2 (95% CI 34.5-57.8) mmHg in term neonates and 48.5 (95%CI 43.0-54.1) mmHg in preterm neonates. Preterm and term infants did not show significant differences in the tcpCO 2 values at any time point. Conclusion: This study demonstrates that tcpCO 2 measurement is feasible during immediate neonatal transition after birth and that tcpCO 2 values were comparable in stable term and preterm neonates.

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Section: Discussionmentioning

confidence: 99%

Feasibilty of Transcutaneous pCO2 Monitoring During Immediate Transition After Birth—A Prospective Observational Study

et al. 2020

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“…Umbilical arterial cannulation is indicated if it is anticipated there will be need for regular blood gas analyses. Transcutaneous oxygen and CO 2 monitoring can also be used to access continuous information for trending but can cause skin injury especially in the most immature infants [152]. Methods of monitoring cerebral oxygenation are also available with potential to assess cerebral saturation, but no clear clinical benefit has been identified [153].…”

Section: Monitoring and Supportive Carementioning

confidence: 99%

European Consensus Guidelines on the Management of Respiratory Distress Syndrome – 2019 Update

et al. 2019

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As management of respiratory distress syndrome (RDS) advances, clinicians must continually revise their current practice. We report the fourth update of “European Guidelines for the Management of RDS” by a European panel of experienced neonatologists and an expert perinatal obstetrician based on available literature up to the end of 2018. Optimising outcome for babies with RDS includes prediction of risk of preterm delivery, need for appropriate maternal transfer to a perinatal centre and timely use of antenatal steroids. Delivery room management has become more evidence-based, and protocols for lung protection including initiation of CPAP and titration of oxygen should be implemented immediately after birth. Surfactant replacement therapy is a crucial part of management of RDS, and newer protocols for its use recommend early administration and avoidance of mechanical ventilation. Methods of maintaining babies on non-invasive respiratory support have been further developed and may cause less distress and reduce chronic lung disease. As technology for delivering mechanical ventilation improves, the risk of causing lung injury should decrease, although minimising time spent on mechanical ventilation using caffeine and, if necessary, postnatal steroids are also important considerations. Protocols for optimising general care of infants with RDS are also essential with good temperature control, careful fluid and nutritional management, maintenance of perfusion and judicious use of antibiotics all being important determinants of best outcome.

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“…Umbilical or radial arterial cannulation is indicated if it is anticipated there will be need for regular blood gas analyses. Transcutaneous oxygen and CO 2 monitoring has also been used to access continuous information for trending but can cause skin injury [123]. Methods of monitoring cerebral oxygenation are also available with potential to guide clinicians about optimal cerebral blood flow but no clear clinical benefit has yet been identified [124].…”

Section: Monitoring and Supportive Carementioning

confidence: 99%

European Consensus Guidelines on the Management of Respiratory Distress Syndrome - 2016 Update

et al. 2016

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Advances in the management of respiratory distress syndrome (RDS) ensure that clinicians must continue to revise current practice. We report the third update of the European Guidelines for the Management of RDS by a European panel of expert neonatologists including input from an expert perinatal obstetrician based on available literature up to the beginning of 2016. Optimizing the outcome for babies with RDS includes consideration of when to use antenatal steroids, and good obstetric practice includes methods of predicting the risk of preterm delivery and also consideration of whether transfer to a perinatal centre is necessary and safe. Methods for optimal delivery room management have become more evidence based, and protocols for lung protection, including initiation of continuous positive airway pressure and titration of oxygen, should be implemented from soon after birth. Surfactant replacement therapy is a crucial part of the management of RDS, and newer protocols for surfactant administration are aimed at avoiding exposure to mechanical ventilation, and there is more evidence of differences among various surfactants in clinical use. Newer methods of maintaining babies on non-invasive respiratory support have been developed and offer potential for greater comfort and less chronic lung disease. As technology for delivering mechanical ventilation improves, the risk of causing lung injury should decrease although minimizing the time spent on mechanical ventilation using caffeine and if necessary postnatal steroids are also important considerations. Protocols for optimizing the general care of infants with RDS are also essential with good temperature control, careful fluid and nutritional management, maintenance of perfusion and judicious use of antibiotics all being important determinants of best outcome.

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Transcutaneous carbon dioxide monitoring for the prevention of neonatal morbidity and mortality

Abstract: There was no evidence to recommend or refute the use of transcutaneous CO2 monitoring in neonates. Well-designed, adequately powered randomized controlled studies are necessary to address efficacy and safety of transcutaneous CO2 monitoring in neonates.

Cited by 16 publications

References 51 publications

Feasibilty of Transcutaneous pCO2 Monitoring During Immediate Transition After Birth—A Prospective Observational Study

Feasibilty of Transcutaneous pCO2 Monitoring During Immediate Transition After Birth—A Prospective Observational Study

European Consensus Guidelines on the Management of Respiratory Distress Syndrome – 2019 Update

European Consensus Guidelines on the Management of Respiratory Distress Syndrome - 2016 Update

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