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

Abstract

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.

Carbon dioxide monitoring in the newborn infant

“…The use and feasibility of transcutaneous electrodes during stabilization and postnatal transition of term and preterm infants not requiring active resuscitation after birth has been assessed in a recent prospective observational study. Average CO 2 values were obtained at 4 min postbirth and reached stable levels by 9 min with similar values reported between those born prematurely and those born at term (48.5 vs. 46.2 mmHg), however, no comparison with blood carbon dioxide level was made 53 . Furthermore, the prolonged time to reach stability of values may preclude the use of transcutaneous monitoring during active resuscitation of infants postbirth, with no studies assessing the utility and feasibility of transcutaneous monitoring to detecting successful intubation.…”

ACE2: the molecular doorway to SARS-CoV-2

“…However, this has not been proven conclusively. In contrast, a growing body of evidence suggests the protective role of sACE [ 26 , 27 ] by its function as decoy ligand to sequester SARS-CoV-2 away from the membrane receptor ACE2 which internalize docked viruses via membrane-associated enzyme dynamics that determines SARS-CoV-2 tissue tropism [ 28 ]. In this line, a genetically modified soluble form of ACE2, called hrsACE2, designed to minimize lung injury and multiple organ dysfunction, competes for membrane-bound ACE2 and thus decreases the cell entry of SARS-CoV-2 into the target cells.…”

Acid base and blood gas analysis in term neonates immediately after birth with uncomplicated neonatal transition

“…This was a post-hoc-analysis of ancillary outcome parameter of a prospective observational study conducted at the Division of Neonatology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, from October 2015 to September 2018. The prospective observational study [ 10 ] was approved by the Regional Committee on Biomedical Research Ethics (EC Number: 27–465 ex 14/15. ), the decision included a possible post-hoc analysis.…”