title: Measuring End-Tidal Carbon Monoxide of Jaundiced Neonates in the Birth Hospital to Identify Those with Hemolysis.
abstract: BACKGROUND
  End-tidal breath carbon monoxide (ETCOc) levels correlate with catabolism of heme, but until recently, this measurement was not readily available for application to neonatology practice.
  
  
  OBJECTIVE
  We performed a prospective, multihospital, test-of-concept study where ETCOc was measured during the birth hospitalization of neonates with a total bilirubin (TB) value >75th percentile on the Bhutani bilirubin nomogram. This was done to test the feasibility and ease of use of this new device.
  
  
  METHODS
  Neonates with an elevated ETCOc (with a >95th percentile reference interval previously established) were labeled as having 'hemolytic jaundice'. We recommended a follow-up TB check <24 h after hospital discharge to these families.
  
  
  RESULTS
  One hundred and fifteen neonates were eligible for the study, the parents of 103 provided consent, and measurements were obtained for 100. Sixty-three had normal and 37 had elevated ETCOc values. By means of a direct antiglobulin test (DAT; Coombs), 11 of these 37 were found positive for ABO hemolytic disease; the remaining 26 had other etiologies. Thirty-six of the 37 with an elevated ETCOc had repeat TB monitoring <24 h after discharge home. None of the 100 were rehospitalized for jaundice treatment compared with a rate of 2.99 rehospitalizations per 100 control neonates who had a TB value >75th percentile (p = 0.079).
  
  
  CONCLUSIONS
  ETCOc measurement is a feasible means of assessing hemolysis in jaundiced neonates during the birth hospitalization. When hemolysis is identified, parents are likely to comply with instructions to bring the infant for a TB checkup <24 h after discharge home.
authors.affiliation: Division of Neonatology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Christensen
authors.forename: Daniel T
authors.initials: DT
authors.lastname: Malleske
authors.forename: Diane K
authors.initials: DK
authors.lastname: Lambert
authors.forename: Vickie L
authors.initials: VL
authors.lastname: Baer
authors.forename: Josef T
authors.initials: JT
authors.lastname: Prchal
authors.forename: Leslie E
authors.initials: LE
authors.lastname: Denson
authors.forename: Erick
authors.initials: E
authors.lastname: Gerday
authors.forename: Kimberlee A
authors.initials: KA
authors.lastname: Weaver Lewis
authors.forename: JuLyn G
authors.initials: JG
authors.lastname: Shepherd
mesh_terms: D001663:Bilirubin / Q000097:blood*; D016550:Birthing Centers; D001944:Breath Tests; D002248:Carbon Monoxide / Q000032:analysis*; D005260:Female; D006403:Hematologic Tests; D006418:Heme / Q000032:analysis; D006461:Hemolysis; D006801:Humans; D006932:Hyperbilirubinemia / Q000175:diagnosis*; D007231:Infant, Newborn; D007567:Jaundice, Neonatal / Q000175:diagnosis*; D008297:Male; D011446:Prospective Studies; D014481:United States
chemical_list: D006418:Heme; D002248:Carbon Monoxide; D001663:Bilirubin