Bahr Timothy M, Shakib Julie H, Stipelman Carole H, Kawamoto Kensaku, Lauer Sarah, Christensen Robert D
Division of Neonatology, Department of Pediatrics, University of Utah Health, Salt Lake City, UT.
Division of General Pediatrics, Department of Pediatrics, University of Utah Health, Salt Lake City, UT.
J Pediatr. 2021 Nov;238:168-173.e2. doi: 10.1016/j.jpeds.2021.07.008. Epub 2021 Jul 11.
To determine, as part of our Utah Newborn Nursery Bilirubin Management Program, whether end-tidal carbon monoxide concentration (ETCOc) measurements in all newborns in our nursery receiving phototherapy were associated with outcomes related to the management of hyperbilirubinemia, including time (hours after birth) when phototherapy was initiated, total duration of phototherapy during the nursery stay, repeat phototherapy treatments, and hospital readmission for phototherapy.
We performed a planned interim analysis of a component of our program in which we measured ETCOc noninvasively using CoSense on each newborn in our nursery receiving phototherapy and recorded specific outcomes related to phototherapy management.
Of 1856 newborns admitted to our nursery in a 6-month period in 2020, 170 (9.8%) were treated with phototherapy. An ETCOc reading was successfully obtained in 145 of 151 attempts (96%). Higher ETCOc values were associated with earlier institution of phototherapy and longer duration of phototherapy. For every 1-ppm increase in ETCOc, phototherapy was started 9 hours earlier (95% CI, 3.3-14.8; P = .002) and was administered for an additional 9.3 hours (95% CI, 4.1-14.6; P < .001). Three newborns were readmitted to the hospital for intensive phototherapy; while in the nursery, all 3 had an elevated ETCOc (2.2, 2.6, and 2.9 ppm).
Our findings provide answers to questions raised in the 2004 American Academy of Pediatrics bilirubin guidelines. In our neonatal nursery, measuring ETCOc in all phototherapy recipients was feasible and safe, and the results were associated with multiple aspects of phototherapy management. Higher ETCOc values predicted earlier and longer phototherapy courses.
作为我们犹他州新生儿重症监护病房胆红素管理项目的一部分，确定在我们接受光疗的新生儿重症监护病房中，所有新生儿的潮气末一氧化碳浓度（ETCOc）测量值是否与高胆红素血症管理的相关结果有关，包括开始光疗的时间（出生后小时数）、在新生儿重症监护病房住院期间光疗的总时长、重复光疗治疗以及因光疗再次入院情况。
我们对项目的一个组成部分进行了计划中的中期分析，在该分析中，我们使用CoSense对我们接受光疗的新生儿重症监护病房中的每个新生儿进行无创ETCOc测量，并记录与光疗管理相关的具体结果。
在2020年6个月期间入住我们新生儿重症监护病房的1856名新生儿中，170名（9.8%）接受了光疗。在151次尝试中有145次（96%）成功获得了ETCOc读数。较高的ETCOc值与更早开始光疗和更长的光疗持续时间相关。ETCOc每增加1 ppm，光疗开始时间提前9小时（95%CI，3.3 - 14.8；P = 0.002），且额外进行9.3小时的光疗（95%CI，4.1 - 14.6；P < 0.001）。三名新生儿因强化光疗再次入院；在新生儿重症监护病房期间，这三名新生儿的ETCOc均升高（2.2、2.6和2.9 ppm）。
我们的研究结果回答了2004年美国儿科学会胆红素指南中提出的问题。在我们的新生儿重症监护病房中，对所有接受光疗的患儿测量ETCOc是可行且安全的，其结果与光疗管理的多个方面相关。较高的ETCOc值预示着更早且更长的光疗疗程。
