End-tidal carbon dioxide levels during resuscitation and carbon dioxide levels in the immediate neonatal period and intraventricular haemorrhage

Kentaro Tamura, Emma E Williams, Theodore Dassios, Anoop Pahuja, Katie A Hunt, Vadivelam Murthy, Prashanth Bhat, Ravindra Bhat, Anthony Milner, Anne Greenough
European Journal of Pediatrics 2020, 179 (4): 555-559
Abnormal levels of end-tidal carbon dioxide (EtCO2 ) during resuscitation in the delivery suite are associated with intraventricular haemorrhage (IVH) development. Our aim was to determine whether carbon dioxide (CO2 ) levels in the first 3 days after birth reflected abnormal EtCO2 levels in the delivery suite, and hence, a prolonged rather than an early insult resulted in IVH. In addition, we determined if greater EtCO2 level fluctuations during resuscitation occurred in infants who developed IVH. EtCO2 levels during delivery suite resuscitation and CO2 levels on the neonatal unit were evaluated in 58 infants (median gestational age 27.3 weeks). Delta EtCO2 was the difference between the highest and lowest level of EtCO2 . Thirteen infants developed a grade 3-4 IVH (severe group). There were no significant differences in CO2 levels between those who did and did not develop an IVH (or severe IVH) on the NICU. The delta EtCO2 during resuscitation differed between infants with any IVH (6.2 (5.4-7.5) kPa) or no IVH (3.8 (2.7-4.3) kPA) (p < 0.001) after adjusting for differences in gestational age. Delta EtCO2 levels gave an area under the ROC curve of 0.940 for prediction of IVH.Conclusion: The results emphasize the importance of monitoring EtCO2 levels in the delivery suite.What is Known:• Abnormal levels of carbon dioxide (CO2 ) in the first few days after birth and abnormal end-tidal CO2 levels (EtCO2 ) levels during resuscitation are associated in preterm infants with the risk of developing intraventricular haemorrhage (IVH).What is New:• There were no significant differences in NICU CO2 levels between those who developed an IVH or no IVH.• There was a poor correlation between delivery suite ETCO2 levels and NICU CO2 levels.• Large fluctuations in EtCO2 during resuscitation in the delivery suite were highly predictive of IVH development in preterm infants.

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