Department of Neonatology, Shenzhen Maternity and Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, Guangdong, China.
J Perinatol. 2024 Jun;44(6):897-901. doi: 10.1038/s41372-024-01967-7. Epub 2024 Apr 16.
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.
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.
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%).
ETCO measurement in the first 48 hours after birth predicts hemolytic hyperbilirubinemia.
在有发生高胆红素血症风险的新生儿中，确定在 48 小时之前测量两次呼气末一氧化碳浓度（ETCOc）是否能够识别出那些将会发生高胆红素血症的患儿，并区分溶血性与非溶血性病因。
对符合“有发生高胆红素血症风险”标准的新生儿进行前瞻性研究。常规胆红素测量和 10 天随访用于将新生儿分类为：（1）正常（无高胆红素血症，所有胆红素<Bhutani 列线图第 95 百分位），（2）发生溶血性高胆红素血症（胆红素≥第 95 百分位，DAT+，升高的网织红细胞或 G6PD+），或（3）发生非溶血性高胆红素血症。
共纳入 386 例新生儿。321 例（83%）未发生高胆红素血症，65 例（17%）发生了高胆红素血症，其中 29 例为溶血性，36 例为非溶血性。高 ETCOc 可区分溶血性组（p<0.001）。第 1 天的 ETCOc 与胆红素和网织红细胞计数相关（r=0.896 和 0.878），且对预测高胆红素血症的敏感性和特异性均很高（83%和 95%）。
出生后 48 小时内的 ETCO 测量可预测溶血性高胆红素血症。
