End-tidal carbon monoxide concentrations measured within 48 hours of birth predict hemolytic hyperbilirubinemia

Xiaoqin Cheng; Bingchun Lin; Yong Yang; Yanliang Yu; Yongping Fu; Chuanzhong Yang

doi:10.1038/s41372-024-01967-7

End-tidal carbon monoxide concentrations measured within 48 hours of birth predict hemolytic hyperbilirubinemia

J Perinatol. 2024 Apr 16. doi: 10.1038/s41372-024-01967-7. Online ahead of print.

Authors

Xiaoqin Cheng¹, Bingchun Lin¹, Yong Yang¹, Yanliang Yu¹, Yongping Fu¹, Chuanzhong Yang²

Affiliations

¹ Department of Neonatology, Shenzhen Maternity and Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, Guangdong, China.
² Department of Neonatology, Shenzhen Maternity and Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, Guangdong, China. yangczgd@163.com.

PMID: 38627593
DOI: 10.1038/s41372-024-01967-7

Abstract

Objectives: To determine, among neonates at-risk for hyperbilirubinemia, whether measuring end-tidal carbon monoxide concentration (ETCOc) twice before 48 hours could identify those who would develop hyperbilirubinemia and differentiate hemolytic vs. non-hemolytic causes.

Methods: Prospective study on neonates meeting criteria "at-risk for hyperbilirubinemia." Routine bilirubin measurements and 10-day follow-up were used to categorize neonates as; (1) normal (no hyperbilirubinemia, all bilirubins <95th percentile of Bhutani nomogram), (2) having hemolytic hyperbilirubinemia (bilirubin ≥95th percentile, DAT+, elevated retic, or G6PD+), or (3) having non-hemolytic hyperbilirubinemia.

Results: 386 neonates were enrolled. 321 (83%) did not develop hyperbilirubinemia and 65 (17%) did, of which 29 were judged hemolytic and 36 non-hemolytic. High ETCOc differentiated the hemolytic group (p < 0.001). First-day ETCOc correlated with bilirubin and with reticulocyte count (r = 0.896 and 0.878) and sensitivity and specificity for predicting hyperbilirubinemia were excellent (83% and 95%).

Conclusions: ETCO measurement in the first 48 hours after birth predicts hemolytic hyperbilirubinemia.