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End-Tidal Carbon Monoxide IV
End-Tidal Carbon Monoxide as an Indicator of the Degree of Hemolysis in Coombs-Positive Babies. Javier MC, Nesin M, and Krauss AN. New York Presbyterian Hospital – Cornell.
Forty-five Coombs-positive term and near-term babies had ETCO measurements made at 24 to 48 hours. CBC and reticulocyte counts were also performed. Nine of 10 patients with reticulocyte counts > 8% had ETCO > 2.5 ppm. Nine of 12 patients who required phototherapy had ETCO > 3 ppm. An ETCO of > 2.5 ppm had a 67% sensitivity and 89% specificity of identifying babies with significant hemolysis. The authors proposed that an ETCO value of > 2.5 ppm at 24 - 48 hours was indicative of significant hemolytic disease.
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; 2-043; 2-045.