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End-Tidal Carbon Monoxide I
Prospective Pre-Discharge (30 +/- 6 Hours) Diagnostic Evaluation Strategies for Severe Neonatal Hyperbilirubinemia. Bhutani VK, Johnson LH, and Stevenson DK. The Jaundice Multinational Study Group.
This group studied total serum bilirubin (TSB) and ETCOc at 30 +/- 6 hours of life in 742 jaundiced infants. In infants with TSB >75 percentile, ETCOc was useful in differentiating increased bilirubin production from delayed bilirubin elimination as a cause for the jaundice. It was also useful to predict which of these babies would later develop TSB > 95 percentile because of increased bilirubin production.
Comment. Rarely do we see as much attention being paid to a single new technology in neonatology as end-tidal carbon monoxide (ETCOc) measurement is receiving this year. The use of ETCOc in the evaluation of neonates with hyperbilirubinemia was the subject of 5 different papers presented at this year’s AAP perinatal section meeting. Carbon monoxide is a byproduct of heme degradation, and it appears that exhaled levels of this gas are directly related to the amount of hemolytic disease present. Brief summaries of the other papers on this topic are linked here: 2-042; 2-043; 2-044; 2-045.