title: Identification of neonatal haemolysis: an approach to predischarge management of neonatal hyperbilirubinemia.
abstract: OBJECTIVE
  Relative contributions of increased production [by end-tidal carbon monoxide concentrations (ETCOc)] and decreased elimination of bilirubin to predischarge hour-specific total bilirubin (TB) levels were assessed in healthy late-preterm and term newborns. Secondly, we report predischarge ETCOc ranges to guide clinical management of hyperbilirubinemia.
  
  
  METHODS
  TB and ETCOc (≤3 timepoints) determinations of newborns aged between six hours and <6 days (n = 79) were stratified by postnatal age epochs. Hyperbilirubinemia risk was assessed by plotting TB values as a function of ETCOc.
  
  
  RESULTS
  Stratifications of ETCOc (in ppm, mean, median and interquartile ranges) by postnatal age epochs (0-24, 24-48 and 48-72) were as follows: 2.0, 1.9, 1.8-2.2 (n = 11); 1.6, 1.5, 1.1-2.0 (n = 58); and 2.0, 1.8, 1.6-2.3 (n = 9), respectively. Infants with ETCOc ≥ 2.5 were at high risk, between 1.5 and 2.5 at moderate risk and ≤1.5 were at low risk. Risk due to haemolysis alone was not independent (p < 0.01). For infants with TB >75th percentile (n = 31), 23% had ETCO ≤1.5, and 77% had ETCOc > 1.5 (p < 0.00003).
  
  
  CONCLUSIONS
  Near-simultaneous ETCOc and TB measurements in infants with TB >75th percentile accurately identify haemolytic hyperbilirubinemia.
authors.affiliation: Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: Vinod K
authors.initials: VK
authors.lastname: Bhutani
authors.affiliation: Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: Shanmukha
authors.initials: S
authors.lastname: Srinivas
authors.affiliation: Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: Martin E
authors.initials: ME
authors.lastname: Castillo Cuadrado
authors.affiliation: Division of General Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: Janelle L
authors.initials: JL
authors.lastname: Aby
authors.affiliation: Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Wong
authors.affiliation: Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: David K
authors.initials: DK
authors.lastname: Stevenson
mesh_terms: D000465:Algorithms; D001663:Bilirubin / Q000097:blood; D015415:Biomarkers / Q000378:metabolism; D002248:Carbon Monoxide / Q000378:metabolism; D000066491:Clinical Decision-Making; D003661:Decision Support Techniques; D005260:Female; D006461:Hemolysis; D006801:Humans; D051556:Hyperbilirubinemia, Neonatal / Q000175:diagnosis* / Q000209:etiology / Q000378:metabolism; D007231:Infant, Newborn; D008297:Male; D010351:Patient Discharge; D000067716:Point-of-Care Testing; D012016:Reference Values
chemical_list: D015415:Biomarkers; D002248:Carbon Monoxide; D001663:Bilirubin
keywords: Bilirubin; Bilirubin elimination; Bilirubin production; End-tidal carbon monoxide; Newborn jaundice