Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

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

Journal of Perinatology volume 40, pages 1513–1517 (2020)Cite this article

Subjects

Abstract

Objective

Determine whether management of neonatal hyperbilirubinemia differs if one used end-tidal carbon monoxide (CO) corrected for ambient CO (ETCOc) measurements instead of direct antiglobulin test (DAT) results to assess the severity of hemolysis.

Study design

Retrospective chart review of infants with total bilirubin and ETCOc levels measured from July 2016 to August 2018. The reported treatment is the hypothetical management infants might have received had there been strict adherence to American Academy of Pediatrics guidelines, rather than the actual management they received.

Result

Only 27.2% of 191 DAT(+) infants were hemolyzing based on ETCOc, while 29.1% of DAT (−) infants were hemolyzing based on ETCOc. Management of 18 (9.4%) infants differed depending if ETCOc or DAT were used to determine hemolysis. Eight fewer infants would have received phototherapy if ETCOc was used.

Conclusions

ETCOc is a more accurate determinant of hemolysis in the newborn, and its use can lead to less phototherapy.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on SpringerLink
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Delaney M, Matthews DC. Hemolytic disease of the fetus and newborn: managing the mother, fetus, and newborn. Hematol Am Soc Hematol Educ Program. 2015;1:146–51.

    Article  Google Scholar 

  2. Moise KJ. Hemolytic disease of the fetus and newborn. In: Creasy RK, Resnik R, editors. Maternal-fetal medicine: principles and practice. 6th ed. Philadelphia: WB Saunders; 2008, p. 477–503.

  3. Maisels MJ, Bhutani VK, Bogen D, Newman TB, Stark AR, Watchko JF. Hyperbilirubinemia in the newborn infant > or =35 weeks’ gestation: an update with clarifications. Pediatrics. 2009;124:1193–8.

    Article  Google Scholar 

  4. Johnson L, Bhutani VK. The clinical syndrome of bilirubin induced neurologic dysfunction. Semin Perinatol. 2011;35:101–13.

    Article  Google Scholar 

  5. Blanchette V, Dror Y, Chan A. Hematology. In: MacDonald MG, Mullett MD, Seschia MMK, editors. Avery’s neonatology: pathophysiology and management of the newborn. Philadelphia: Lippincott, Wiliams and Wilkins; 2005, p. 1169–234.

  6. Nilsen ST, Finne PH, Bergesjo P, Stamnes O. Males with neonatal hyperbilirubinemia examined at 18 years of age. Acta Paediatr Scand. 1984;73:176–80.

    Article  CAS  Google Scholar 

  7. Christensen RD, Henry E, Bennett ST, Yaishi HM. Reference interval for reticulcyte parameters of infants during their first 90 days after birth. J Perinatol. 2016;36:61–6.

    Article  CAS  Google Scholar 

  8. Schutzman DL, Gatien E, Ajayi S, Wong RJ. Carboxyhemoglobin levels as a predictor of risk for significant hyperbilirubinemia in African American DAT+ infants. J Perinatol. 2016;36:386–8.

    Article  CAS  Google Scholar 

  9. Mentzer WC, Glader BE. Erythrocyte disorders in infancy. In: Taeusch HW, Ballard RA, editors. Avery’s diseases of the newborn. 8th ed. Philadelphia: Elsevier Saunders; 2005, p. 1180–214.

  10. Gozzelino R, Jeney V, Soares MP. Mechanisms of cell protection by heme oxygenase-1. Annu Rev Pharm Toxicol. 2010;50:323–54.

    Article  CAS  Google Scholar 

  11. Coburn RF, Williams WJ, Kahn SB. Endogenous carbon monoxide production in patients with hemolytic anemia. J Clin Inves. 1966;45:460–8.

    Article  CAS  Google Scholar 

  12. Wong RJ, Bhutani VK, Stevenson DK. The importance of hemolysis and its clinical detection in neonates with hyperbilirubinemia. Curr Pediatr Rev. 2017;13:193–8.

    Article  CAS  Google Scholar 

  13. Stevenson DK, Vreman HJ. Carbon monoxide and bilirubin production in neonates. Pediatrics. 1997;100:252–9.

    Article  CAS  Google Scholar 

  14. American Academy of Pediatrics Subcommittee on Hyperbilirubinemia. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics. 2004;114:297–316.

    Article  Google Scholar 

  15. Bhutani VK, Srinivas S, Castillo Cuadrado ME, Aby JL, Wong RJ, Stevenson DK. Identification of neonatal haemolysis: an approach to predischarge management of neonatal hyperbilirubinemia. Acta Paediatr. 2016;105:e189–94.

    Article  CAS  Google Scholar 

  16. Christensen RD, Malleske DT, Lambert DK, Baer VL, Prchal JT, Denson LE, et al. Measuring end tidal carbon monoxide of jaundiced neonates in the birth hospital to identify those with hemolysis. Neonatology. 2016;109:1–5.

    Article  CAS  Google Scholar 

  17. Bhutani VK, Maisels MJ, Schutzman DL, Cuadrado MEC, Aby J, Bogen DL, et al. Identification of risk for neonatal hemolysis. Acta Paediatr. 2018;107:1350–6.

    Article  CAS  Google Scholar 

  18. Bhutani VK, Johnson L, Sivieri EM. Predictive ability of a predischarge hour-specific serum bilirubin for subsequent significant hyperbilirubinemia in healthy term and near-term newborns. Pediatrics. 1999;103:6–14.

    Article  CAS  Google Scholar 

  19. Vreman HJ, Kwong LK, Stevenson DK. Carbon monoxide in blood: an improved microliter blood sample collection system, with rapid analysis by gas chromatography. Clin Chem. 1984;30:1382–6.

    Article  CAS  Google Scholar 

  20. Herschel M, Karrison T, Wen M, Calderelli L, Baron B. Evaluation of the direct antiglobulin (Coombs) test for identifying newborns at risk for hemolysis as determined by end-tidal carbon monoxide concentration (ETCOc); and comparison of the Coombs test with ETCOc for detecting significant jaundice. J Perinatol. 2002;22:341–7.

    Article  Google Scholar 

  21. Ramy N, Ghany EA, Alsharany W, Nada A, Darwish RK, Rabie WA, et al. Jaundice phototherapy and DNA damage in full-term neonates. J Perinatol. 2016;36:132–6.

    Article  CAS  Google Scholar 

  22. Newman TB, Wu YW, Kuzniewicz MW, Grimes BA, McCulloch CE. Childhood seizures after phototherapy. Pediatrics. 2018;142:32.

    Article  Google Scholar 

  23. Johnson L, Bhutani VK, Karp K, Sivieri EM, Shapiro SM. Clinical report from the pilot USA kernicterus registry (1992 to 2004). J Perinatol. 2009;29:S25–45.

    Article  Google Scholar 

  24. Maisels MJ, Kring E. The contribution of hemolysis to early jaundice in normal newborns. Pediatrics. 2006;118:276–9.

    Article  Google Scholar 

Download references

Acknowledgements

The authors would like to acknowledge Andrew Paoletti for his assistance with statistics.

Author information

Authors and Affiliations

  1. Department of Neonatology, Baylor College of Medicine, Houston, TX, USA

    A. L. Elsaie

  2. Department of Pediatrics, Einstein Medical Center Philadelphia, Philadelphia, PA, USA

    M. Taleb, K. Newton & D. L. Schutzman

  3. Division of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA

    A. Nicosia

  4. Division of Neonatology, SUNY Downstate, Brooklyn, NY, USA

    A. Zangaladze

  5. Department of Neonatology, Saint Christopher’s Hospital for Children, Philadelphia, PA, USA

    M. E. Pease

Authors
  1. A. L. Elsaie
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Taleb
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. Nicosia
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. Zangaladze
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M. E. Pease
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. K. Newton
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. D. L. Schutzman
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

DLS was responsible for the study concept, design, data interpretation, and preparation of the manuscript. ALE and MT were responsible for the study design, data collection and interpretation, and critical review of the manuscript. AN, AZ, MEP, and KN were responsible for data collection, interpretation, and critical review of the manuscript.

Corresponding author

Correspondence to D. L. Schutzman.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Elsaie, A.L., Taleb, M., Nicosia, A. et al. Comparison of end-tidal carbon monoxide measurements with direct antiglobulin tests in the management of neonatal hyperbilirubinemia. J Perinatol 40, 1513–1517 (2020). https://doi.org/10.1038/s41372-020-0652-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41372-020-0652-y

This article is cited by

Search

Advanced search

Quick links