Transcutaneous CO[sub.2] Monitoring in Extremely Low Birth Weight Premature Infants

• Published in: Journal of clinical medicine 2023-09, Vol.12 (17)
• Main Authors: Borenstein-Levin, Liron, Avishay, Noa, Soffer, Orit, Arnon, Shmuel, Riskin, Arieh, Dinur, Gil, Lavie-Nevo, Karen, Gover, Ayala, Kugelman, Amir, Hochwald, Ori
• Format: Article
• Language: English
• Subjects: Birth weight, Low; Carbon dioxide; Care and treatment; Health aspects; Infants (Premature); Measurement; Methods; Neonatal intensive care; Pediatric research; Physiological aspects; Transcutaneous blood gas monitoring
• ISSN: 2077-0383; 2077-0383
• DOI: 10.3390/jcm12175757

Extremely low birth weight (ELBW) premature infants are particularly susceptible to hypocarbia and hypercarbia, which are associated with brain and lung morbidities. Transcutaneous CO[sub.2] (TcCO[sub.2] ) monitoring allows for continuous non-invasive CO[sub.2] monitoring during invasive and non-invasive ventilation and is becoming more popular in the NICU. We aimed to evaluate the correlation and agreement between CO[sub.2] levels measured by a TcCO[sub.2] monitor and blood gas CO[sub.2] (bgCO[sub.2] ) among ELBW infants. This was a prospective observational multicenter study. All infants < 1000 g admitted to the participating NICUs during the study period were monitored by a TcCO[sub.2] monitor, if available. For each bgCO[sub.2] measured, a simultaneous TcCO[sub.2] measurement was documented. In total, 1828 pairs of TcCO[sub.2] –bgCO[sub.2] values of 94 infants were collected, with a median (IQR) gestational age of 26.4 (26.0, 28.3) weeks and birth weight of 800 (702, 900) g. A moderate correlation (Pearson: r = 0.64) and good agreement (bias (95% limits of agreement)):(2.9 [−11.8, 17.6] mmHg) were found between the TcCO[sub.2] and bgCO[sub.2] values in the 25–70 mmHg TcCO[sub.2] range. The correlation between the TcCO[sub.2] and bgCO[sub.2] trends was moderate. CO[sub.2] measurements by TcCO[sub.2] are in good agreement (bias < 5 mmHg) with bgCO[sub.2] among premature infants < 1000 g during the first week of life, regardless of day of life, ventilation mode (invasive/non-invasive), and sampling method (arterial/capillary/venous). However, wide limits of agreement and moderate correlation dictate the use of TcCO[sub.2] as a complementary tool to blood gas sampling, to assess CO[sub.2] levels and trends in individual patients.