Comparison of end-tidal carbon monoxide measurements with direct antiglobulin tests in the management of neonatal hyperbilirubinemia

El-Saie, Ahmed; Taleb, M; Nicosia, Angelo; Zangaladze, Anano; Pease, Mary Ellen; Newton, K. P.; Schutzman, David L.

doi:10.1038/s41372-020-0652-y

Cited by 17 publications

(5 citation statements)

References 23 publications

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“…Hemolysis-induced increase in CO production in neonates, as detected as elevated COHb in the blood by CO-oximetry,6 gas chromatography,7–11 or elevated end-tidal CO,12,13 has been reported in several studies. Measurement of COHb with CO-oximetry is available from point-of-care analyzers; therefore, this method appears reasonable and useful to detect hemolytic processes in neonates.…”

Section: Discussionmentioning

confidence: 97%

Clinical Factors Influencing Endogenous Carbon Monoxide Production and Carboxyhemoglobin Levels in Neonates

Krivec

Manfreda

Paro–Panjan

2021

Journal of Pediatric Hematology/Oncology

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Carboxyhemoglobin (COHb) is an index of endogenous carbon monoxide formation during the hem degradation process and could be used to confirm hemolysis in neonates. The influence of other clinical factors on COHb values in neonates has not been fully investigated. We aimed to evaluate the influence of hemolysis, sepsis, respiratory distress, and postnatal age on COHb values. We retrospectively analyzed COHb measurements determined with a carbon monoxide-oximeter in 4 groups of term neonates: A—sepsis, B—respiratory distress, C—hemolysis, and D—healthy neonates. The mean COHb values were 1.41% (SD: 0.26), 1.32% (SD: 0.27), 2.5% (SD: 0.69), and 1.27% (SD: 0.19) (P<0.001) in groups A (n=8), B (n=37), C (n=16), and D (n=76), respectively. COHb in group C was significantly higher than in the other groups. There was a negative correlation between postnatal age and COHb in healthy neonates. A cut-off level of 1.7% had 93% (95% confidence interval [CI]: 89%-97%) sensitivity and 94% (95% CI: 90%-98%) specificity for diagnosis of hemolysis. COHb values were higher during the first days of life. We found that COHb levels in neonates with hemolysis were significantly higher and that the influence of sepsis and respiratory distress on COHb values was insignificant.

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Section: Discussionmentioning

confidence: 97%

Clinical Factors Influencing Endogenous Carbon Monoxide Production and Carboxyhemoglobin Levels in Neonates

Krivec

Manfreda

Paro–Panjan

2021

Journal of Pediatric Hematology/Oncology

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“…During heme catabolism, carbon monoxide is produced in equimolar amounts with bilirubin. Therefore, this noninvasive method may provide a more accurate way to identify infants at risk for developing severe hyperbilirubinemia in comparison to the antiglobulin test [41,[55][56][57][58]. Pediatricians ought to be aware of potential neurotoxicity risk factors that may exist besides HDFN and may lead to an increased susceptibility for bilirubin encephalopathy.…”

Section: Early Phase: Hyperbilirubinemiamentioning

confidence: 99%

History and current standard of postnatal management in hemolytic disease of the fetus and newborn

et al. 2022

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Since the discovery of the Rh blood group system in 1940, a greater understanding of hemolytic disease of the fetus and newborn (HDFN) was gained. In the years thereafter, researchers and clinicians came to the current understanding that fetal and neonatal red blood cells (RBC) are hemolyzed by maternal alloantibodies directed against RBC antigens potentially leading to severe disease. Preventative measures, such as Rhesus(D) immunoprophylaxis (RhIG), have greatly decreased the prevalence of Rh(D)-mediated HDFN, although a gap between high-income countries and middle-to low-income countries was created largely due to a lack in availability and high costs of RhIG. Other important developments in the past decades have improved the identification, monitoring, and care of pregnancies, fetuses, and neonates with HDFN. Prenatally, fetal anemia may occur and intrauterine transfusions may be needed. Postnatally, pediatricians should be aware of the (antenatally determined) risk of hemolysis in RBC alloimmunization and should provide treatment for hyperbilirubinemia in the early phase and monitor for anemia in the late phase of the disease. Through this review, we aim to provide an overview of important historic events and to provide hands-on guidelines for the delivery and postnatal management of neonates with HDFN. Secondarily, we aim to describe recent scientific findings and evidence gaps.Conclusion: Multiple developments have improved the identification, monitoring, and care of pregnancies and neonates with HDFN throughout the centuries. Pediatricians should be aware of the (antenatally determined) risk of hemolysis in RBC alloimmunization and should provide treatment for hyperbilirubinemia in the early phase and monitor for late anemia in the late phase of the disease. Future studies should be set in an international setting and ultimately aim to eradicate HDFN on a global scale. What is Known:• Developments have led to a greater understanding of the pathophysiology, an improved serological identification and monitoring of at-risk cases and the current pre-and postnatal treatment. What is New:• This review provides the pediatrician with hands-on guidelines for the delivery and postnatal management of neonates with HDFN.• Future studies should be set in an international setting with the ultimate aim of eradicating HDFN.

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“…The measurement of ETCO as a marker of haemolysis was traditionally performed using GC [ 118 ], but this has transitioned to the contemporary use of more portable and non-invasive systems, such as the CoSense ® CO monitor (Capnia, Inc., Redwood City, CA, USA), which exhibit sufficient accuracy and precision for the detection of haemolysis in neonates. Studies on ETCO have shown that concentrations ≥ 2.5 ppm (corrected for ambient CO) are indicative of the presence of significant haemolysis [ 119 , 120 , 121 , 122 ], and that this breath-based test exhibits a higher accuracy compared to the direct anti-globulin test (DAT) [ 123 ]. Moreover, a study from 2001 found a correlation between the ETCO level associated with neonatal jaundice, even in infants without haemolytic diseases, with high sensitivity, specificity and negative predictive values (86, 80 and 97%, respectively) [ 109 ].…”

Section: Tests Targeting Endogenous Compoundsmentioning

confidence: 99%

Breath Biomarkers in Diagnostic Applications

Pham

Beauchamp

2021

Molecules

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The detection of chemical compounds in exhaled human breath presents an opportunity to determine physiological state, diagnose disease or assess environmental exposure. Recent advancements in metabolomics research have led to improved capabilities to explore human metabolic profiles in breath. Despite some notable challenges in sampling and analysis, exhaled breath represents a desirable medium for metabolomics applications, foremost due to its non-invasive, convenient and practically limitless availability. Several breath-based tests that target either endogenous or exogenous gas-phase compounds are currently established and are in practical and/or clinical use. This review outlines the concept of breath analysis in the context of these unique tests and their applications. The respective breath biomarkers targeted in each test are discussed in relation to their physiological production in the human body and the development and implementation of the associated tests. The paper concludes with a brief insight into prospective tests and an outlook of the future direction of breath research.

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Comparison of end-tidal carbon monoxide measurements with direct antiglobulin tests in the management of neonatal hyperbilirubinemia

Cited by 17 publications

References 23 publications

Clinical Factors Influencing Endogenous Carbon Monoxide Production and Carboxyhemoglobin Levels in Neonates

Clinical Factors Influencing Endogenous Carbon Monoxide Production and Carboxyhemoglobin Levels in Neonates

History and current standard of postnatal management in hemolytic disease of the fetus and newborn

Breath Biomarkers in Diagnostic Applications

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