Measuring End-Tidal Carbon Monoxide of Jaundiced Neonates in the Birth Hospital to Identify Those with Hemolysis:

Christensen RD, Malleske DT, Lambert DK, Baer VL, Prchal JT, Denson LE, Gerday E, Weaver Lewis KA, Shepherd JG. Measuring End-Tidal Carbon Monoxide of Jaundiced Neonates in the Birth Hospital to Identify Those with Hemolysis. Neonatology. 2016;109(1):1-5.

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Non-invasive Detection of Hemolysis: Changing the Jaundice Management Paradigm

At the 2015 joint European Neonatology Society (jENS) Meeting in Budapest, Hungary, a distinguished faculty discussed jaundice management and the role of the CoSense® ETCO Monitor in the non-invasive detection of hemolysis.

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DESIGN

Prospective

POPULATION & SAMPLE SIZE

Newborns, ≥ 35 weeks gestational age (GA), n=79

OBJECTIVE

Report predischarge ETCOc ranges to guide clinical management of hyperbilirubimia

KEY FINDINGS

Elevated ETCOc level (>1.5ppm) and/or excessive rate of TB rise (0.2mg/dL/h) may identify infants most at risk Confirms previous reports that pre-discharge measurements of TB together with ETCO can be used as an index of increased bilirubin loads due to hemolysis

ARTICLE LINK

http://www.ncbi.nlm.nih.gov/pubmed/26802319

DESIGN

Prospective; Prospective Controlled

POPULATION & SAMPLE SIZE

Newborns, ≥ 37 weeks gestational age (GA), n=30; Neonates & children with hemolytic disorders, n=40

OBJECTIVE

Assess the feasibility of ETCO measurements and determine if there is a significant difference in ETCO values between hemolyzers and non-hemolyzers

KEY FINDINGS

ETCO1 values of the subjects with known hemolysis were higher than the age-matched healthy controls (p<0.0001)

Neonates with hemolytic conditions can be recognized using CoSense and be targeted for rigorous follow-up/treatment

ARTICLE LINK

http://www.ncbi.nlm.nih.gov/pubmed/26802319

DESIGN

Bench Testing / Prospective Clinical Study

POPULATION & SAMPLE SIZE

Newborns, ≥ 30 weeks gestational age (GA), n=83

OBJECTIVE

Evaluate the accuracy of CoSense versus blood carboxyhemoglobin (COHb), the “gold standard” for detecting hemolysis

KEY FINDINGS

Strong linear correction (r=.93) between ETCO and COHb

CoSense can identify the presence of hemolysis in infants

CoSense can identify the presence of hemolysis in infants

ARTICLE LINK

http://www.ncbi.nlm.nih.gov/pubmed/25640053

DESIGN

Prospective Controlled

POPULATION & SAMPLE SIZE

Children (5-14) with and without SCA, n=33

OBJECTIVE

Evaluate the ability of CoSense to detect hemolysis in patients with a known hemolytic condition

KEY FINDINGS

ETCO values 5-fold higher in SCA subjects than controls

ETCO values correlated with reticulocytes and bilirubin

ARTICLE LINK

http://www.ncbi.nlm.nih.gov/pubmed/25683629

DESIGN

Prospective

POPULATION & SAMPLE SIZE

Neonates with significant HB (SHB), n=56

OBJECTIVE

Test CoSense‘s ability to detect hemolysis in neonates with SHB.

KEY FINDINGS

CoSense provided similar information as invasive blood tests (DAT, retic count, hematocrit and bilirubin), confirming feasibility of detecting hemolysis using a simple breath test

DESIGN

Post Hoc Analysis

POPULATION & SAMPLE SIZE

Newborns ≥ 35 weeks GA, n=793

OBJECTIVE

Characterize the roles of increased bilirubin production and impaired bilirubin elimination to the development of HB.

KEY FINDINGS

Increased bilirubin production in ~80%, 42%, and 32% infants in high-, intermediate-, and low-risk TB zones, respectively

Pre-discharge assessment of risk with ETCO

ARTICLE LINK

http://www.ncbi.nlm.nih.gov/pubmed/25880796

DESIGN

Systematic Review

POPULATION & SAMPLE SIZE

N/A

OBJECTIVE

Describe ETCO & its application in identifying infants at risk for developing hyperbilirubinemia (HB) associated with hemolysis

KEY FINDINGS

Elevated levels of ETCO have been correlated with hemolysis in newborns suggesting that accurate, rapid analysis of ETCO may provide a useful tool for identifying newborns with HB requiring greater attention

ARTICLE LINK

http://www.nature.com/jp/journal/v34/n8/full/jp201466a.html

DESIGN

Guideline

POPULATION & SAMPLE SIZE

N/A

OBJECTIVE

Provide guidance on how to manage HB in newborns ≥ 35 weeks of gestation

KEY FINDINGS

Standard lab tests for hemolysis are frequently unhelpful ETCO confirms the presence or absence of hemolysis and is the only clinical test that provides a direct measurement of bilirubin production

ARTICLE LINK

http://www.ncbi.nlm.nih.gov/pubmed/15231951

DESIGN

Retrospective

POPULATION & SAMPLE SIZE

Newborns ≥ 36 weeks GA, n=54,795

OBJECTIVE

Reanalyze data from the CPP to investigate whether bilirubin is more neurotoxic in newborns with a positive DAT (used as a surrogate for hemolysis)

KEY FINDINGS

There is an association between TSB levels ≥ 25 mg/dL, a positive DAT, and lower IQ scoresSupports AAP recommendation to treat at a lower level of jaundice with a positive DAT Reinforces findings of Newman et al. NEJM. 2006;354(18).

ARTICLE LINK

http://www.ncbi.nlm.nih.gov/pubmed/19255038

DESIGN

Prospective Observational

POPULATION & SAMPLE SIZE

Preterm infants ≤ 32 weeks GA, n=105

OBJECTIVE

Evaluate the predictive value of ETCO and cytokine levels for long-term outcome

KEY FINDINGS

ETCO < 2.0 ppm in the first 24 hours of life is high predictive of a favorable neurodevelopmental outcome at 3.5 years

Majority of children with an ETCO > 2.0 ppm in the first 24 hours of life had adverse neurodevelopmental outcomes

ARTICLE LINK

http://www.ncbi.nlm.nih.gov/pubmed/21933176

DESIGN

Systematic Review

POPULATION & SAMPLE SIZE

N/A

OBJECTIVE

Describe the causes of neonatal hemolysis and the risk of BIND associated with neonates with hemolytic disease

KEY FINDINGS

Severe HB in newborns can be caused by hemolysis, which results from a number of different conditions Infants with hemolytic disease are at greater risk of developing bilirubin-induced neurotoxicity and BIND

ARTICLE LINK

http://www.ncbi.nlm.nih.gov/pubmed/25560401

DESIGN

Retrospective

POPULATION & SAMPLE SIZE

Neonates with bilirubin ≥ 25 mg/dL, n=12

OBJECTIVE

Evaluate a quality improvement process to diagnose hemolytic conditions in neonates with HB.

Many of the cases of extreme HB have an underlying basis involving hemolysis Inherited conditions such as hereditary spherocytosis and G6PD deficiency can be missed in neonates

ARTICLE LINK

http://www.ncbi.nlm.nih.gov/pubmed/24762414

DESIGN

Prospective Controlled

POPULATION & SAMPLE SIZE

Newborns, n=272

OBJECTIVE

Clarify the contribution of an increase in bilirubin production in HB in newborns

Hemolysis is an important mechanism responsible for HB in the first 4 days of life

ARTICLE LINK

http://www.ncbi.nlm.nih.gov/pubmed/16818575


1. ETCO = ETCOc, end-tidal carbon monoxide corrected for ambient carbon monoxide.

Clinical References – Soleno