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End-Tidal Carbon Monoxide II
End-Tidal Carbon Monoxide Hour-Specific Nomogram for Early and Pre-Discharge Identification of Babies with Increased Bilirubin Production. Bhutani VK, Herschel M, and Stevenson DK. The Jaundice Multinational Study Group.
This report establishes an hour-specific "normal range" for ETCOc measurements in term and near-term infants between 6 and 36 hours old who are born to non-smoking mothers. The data was tabulated from 2074 ETCOc measurements done on 1479 infants at 10 clinical sites. It is presented in the form of a nomogram showing age in hours on the x-axis and ETCOc measurement on the y-axis. The graph shows a plot of the mean and 25th and 75th percentiles. ETCOc values > 1.6 ppm were above the 75 percentile for infants over 30 hours of age.
Comment. It was also notable that while infants of smoking mothers had elevated ETCOc levels shortly after birth, those differences were not apparent after 12 hours of age in this study.
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: 2-041; 2-043; 2-044; 2-045.