Measuring End-Tidal Carbon Monoxide of Jaundiced Neonates in the Birth Hospital to Identify Those with Hemolysis

Abstract

Background: End-tidal breath carbon monoxide (ETCOc) levels correlate with catabolism of heme, but until recently, this measurement was not readily available for application to neonatology practice. Objectives: We performed a prospective, multihospital, test-of-concept study where ETCOc was measured during the birth hospitalization of neonates with a total bilirubin (TB) value >75th percentile on the Bhutani bilirubin nomogram. This was done to test the feasibility and ease of use of this new device. Methods: Neonates with an elevated ETCOc (with a >95th percentile reference interval previously established) were labeled as having ‘hemolytic jaundice'. We recommended a follow-up TB check <24 h after hospital discharge to these families. Results: One hundred and fifteen neonates were eligible for the study, the parents of 103 provided consent, and measurements were obtained for 100. Sixty-three had normal and 37 had elevated ETCOc values. By means of a direct antiglobulin test (DAT; Coombs), 11 of these 37 were found positive for ABO hemolytic disease; the remaining 26 had other etiologies. Thirty-six of the 37 with an elevated ETCOc had repeat TB monitoring <24 h after discharge home. None of the 100 were rehospitalized for jaundice treatment compared with a rate of 2.99 rehospitalizations per 100 control neonates who had a TB value >75th percentile (p = 0.079). Conclusion: ETCOc measurement is a feasible means of assessing hemolysis in jaundiced neonates during the birth hospitalization. When hemolysis is identified, parents are likely to comply with instructions to bring the infant for a TB checkup <24 h after discharge home.

Infantile Pyknocytosis: End-Tidal CO, %Micro-R Measurements, Next-Generation Sequencing, and Transfusion Avoidance with Darbepoetin

“…The kinetic cause of this variety of anemia is thought to be hemolytic, on the basis of hyperbilirubinemia and reticulocytosis. Our findings of an elevated end-tidal CO and absent haptoglobin are supportive of a hemolytic pathogenesis [24,25].…”

Inhaled Carbon Monoxide: From Toxin to Therapy

“…Lozar-Krivec and colleagues 75 found that HbCO was higher in newborns with hemolysis than in those without hemolysis. The authors of several studies [76][77][78] suggest that measurement of exhaled CO is a feasible approach to assessing hemolysis in jaundiced neonates. Exhaled CO might also be useful to monitor hemolysis in children with sickle cell disease.…”

Improving the Bilirubin Management Program in the Newborn Nursery: Background, Aims, and Protocol

“…FDA-approved point-of-care noninvasive monitors can quantify the end-tidal CO of neonates. Our recent work, and that of others, has shown that measuring ET-COc during newborn hospitalization can identify hemolysis [19][20][21]. In our new management program, we will obtain an ETCOc on all neonates who meet the phototherapy initiation criteria.…”