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End-Tidal Carbon Monoxide III
Comparison of the Direct Coombs Antiglobulin Test (DAT) for Identification of Newborns at Risk or Not at Risk for Hemolysis with a Known Indicator of the Rate of Hemolysis, the End-Tidal Carbon Monoxide Concentration in Parts per Million Corrected for Inhaled CO (ETCOc). Herschel M, Karrison T, Wen M, et al. University of Chicago, IL.
660 consecutive newborns were studied DAT tests and ETCOc measurements at 12 and 24 hours of age. The DAT only had a sensitivity of 38% in predicting an ETCOc > 95%ile at 12 hours of age, and only 8.5% sensitivity at 24 hours of age. The authors concluded that ETCOc was a more useful clinical test than DAT for identification of hemolysis in newborns.
Comment. There was no measurement of bilirubin levels reported in this study, and no mention of the sensitivity of ETCOc levels > 95%ile in predicting clinically significant hemolytic disease. Also of note: In this study there was a significant elevation of ETCOc levels in infants born to smoking mothers at 12 hours. This difference disappeared by 24 hours.
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; 2-042; 2-044; 2-045.