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End-tidal carbon monoxide concentrations measured within 48 hours of birth predict hemolytic hyperbilirubinemia

Journal of Perinatology (2024)Cite this article

Subjects

Abstract

Objectives

To determine, among neonates at-risk for hyperbilirubinemia, whether measuring end-tidal carbon monoxide concentration (ETCOc) twice before 48 hours could identify those who would develop hyperbilirubinemia and differentiate hemolytic vs. non-hemolytic causes.

Methods

Prospective study on neonates meeting criteria “at-risk for hyperbilirubinemia.” Routine bilirubin measurements and 10-day follow-up were used to categorize neonates as; (1) normal (no hyperbilirubinemia, all bilirubins <95th percentile of Bhutani nomogram), (2) having hemolytic hyperbilirubinemia (bilirubin ≥95th percentile, DAT+, elevated retic, or G6PD+), or (3) having non-hemolytic hyperbilirubinemia.

Results

386 neonates were enrolled. 321 (83%) did not develop hyperbilirubinemia and 65 (17%) did, of which 29 were judged hemolytic and 36 non-hemolytic. High ETCOc differentiated the hemolytic group (p < 0.001). First-day ETCOc correlated with bilirubin and with reticulocyte count (r = 0.896 and 0.878) and sensitivity and specificity for predicting hyperbilirubinemia were excellent (83% and 95%).

Conclusions

ETCO measurement in the first 48 hours after birth predicts hemolytic hyperbilirubinemia.

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Fig. 1: Flowchart of enrollment and follow-up evaluation of study subjects.
Fig. 2: The ROC curve for the predictive abilities of hemolysis.

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Acknowledgements

We thank Capina company for providing the ETCO instruments and equipment. We thank our patients and their parents for participating in our study. We thank Dr. Xueyu Chen (Shenzhen Maternity and Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University) for her competent advice.

Funding

This research was supported by the Shenzhen Fund for Guangdong Provincial Highlevel Clinical Key Specialties (No. SZGSP009).

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Authors and Affiliations

  1. Department of Neonatology, Shenzhen Maternity and Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, Guangdong, China

    Xiaoqin Cheng, Bingchun Lin, Yong Yang, Yanliang Yu, Yongping Fu & Chuanzhong Yang

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  1. Xiaoqin Cheng
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  2. Bingchun Lin
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  3. Yong Yang
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  4. Yanliang Yu
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  5. Yongping Fu
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Contributions

Xiaoqin Cheng conceptualized and designed the study, included patients, collected the data, performed the statistical analyses, drafted the initial manuscript, and reviewed and revised the manuscript. Bingchun Lin, Yong Yang, Yanliang Yu, and Yongping Fu revised the manuscript. Chuanzhong Yang provided guidance for this study. All authors approved the final manuscript as submitted and agreed to be accountable for all aspects of the work.

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Correspondence to Chuanzhong Yang.

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Cheng, X., Lin, B., Yang, Y. et al. End-tidal carbon monoxide concentrations measured within 48 hours of birth predict hemolytic hyperbilirubinemia. J Perinatol (2024). https://doi.org/10.1038/s41372-024-01967-7

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  • DOI: https://doi.org/10.1038/s41372-024-01967-7

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