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Non-invasive carbon dioxide monitoring in neonates: methods, benefits, and pitfalls

Journal of Perinatology volume 41, pages 2580–2589 (2021)Cite this article

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A Correction to this article was published on 14 September 2021

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Abstract

Wide fluctuations in partial pressure of carbon dioxide (PaCO2) can potentially be associated with neurological and lung injury in neonates. Blood gas measurement is the gold standard for assessing gas exchange but is intermittent, invasive, and contributes to iatrogenic blood loss. Non-invasive carbon dioxide (CO2) monitoring has become ubiquitous in anesthesia and critical care and is being increasingly used in neonates. Two common methods of non-invasive CO2 monitoring are end-tidal and transcutaneous. A colorimetric CO2 detector (a modified end-tidal CO2 detector) is recommended by the International Liaison Committee on Resuscitation (ILCOR) and the American Academy of Pediatrics to confirm endotracheal tube placement. Continuous CO2 monitoring is helpful in trending PaCO2 in critically ill neonates on respiratory support and can potentially lead to early detection and minimization of fluctuations in PaCO2. This review includes a description of the various types of CO2 monitoring and their applications, benefits, and limitations in neonates.

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Fig. 1: Time capnogram in which end-tidal CO2 (EtCO2) is traced against time.
Fig. 2: Types of EtCO2 monitoring.
Fig. 3: Trancutaneous CO2 monitoring.
Fig. 4: Confirmation of the endotracheal tube (ETT) placement in the delivery room.
Fig. 5: Importance of capnography in confirmation of endotracheal tube (ETT) position.
Fig. 6: Causes for persistent purple coloration of colorimetric CO2 detector in neonates.

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Acknowledgements

The authors would like to thank the funding sources listed below.

Funding

UC Davis Children’s Miracle Network, UC Davis Child Health Research Grant and First Tech Federal Union, Canadian Pediatric Society-Neonatal Resuscitation Program Research Grant, National Institutes of Health (NIH)/National Heart Lung and Blood Institute (NHLBI) K12 HL138052, HD072929 and UL1TR001412, and Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD).

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Authors and Affiliations

  1. Division of Neonatology, Department of Pediatrics, University of California Davis, Sacramento, CA, USA

    Deepika Sankaran, Lida Zeinali & Satyan Lakshminrusimha

  2. Division of Neonatology, Children’s Hospital of Orange County, Orange, CA, USA

    Sameeia Iqbal

  3. Division of Neonatology, Department of Pediatrics, University at Buffalo, Buffalo, NY, USA

    Praveen Chandrasekharan

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  1. Deepika Sankaran
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  2. Lida Zeinali
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  3. Sameeia Iqbal
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  4. Praveen Chandrasekharan
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  5. Satyan Lakshminrusimha
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Contributions

DS conceptualized, designed, drafted the initial manuscript, reviewed, and revised the manuscript. LZ, SI, PC, and SL contributed to the concept, reviewed, and revised the manuscript. All the authors have critically revised and approved the final version of the manuscript. All authors agree to be accountable for all aspects of the work.

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Correspondence to Deepika Sankaran.

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Financial disclosure

Dr. Sankaran is supported by UC Davis Children’s Miracle Network, UC Davis Child Health Research Grant and First Tech Federal Credit Union, and Neonatal Resuscitation Program Research Grant from the Canadian Pediatric Society. Dr. Chandrasekharan is supported by the National Institutes of Health (NIH)/National Heart Lung and Blood Institute (NHLBI) K12 HL138052 and Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) R03HD096510. Research reported in this publication was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under award number UL1TR001412 to the University at Buffalo. Dr. Lakshminrusimha is supported by NICHD (HD072929). The funding agencies did not have any role in the design or submission of this manuscript. This review article does not contain a discussion of an unapproved/investigative use of a commercial product/device.

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The authors declare no competing interests.

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The original online version of this article was revised: Under the heading “Types of non-invasive carbon dioxide monitoring” and subheading “Physical method (waveform capnography)” there is a number mentioned as “0.43 µm" which is an error, and it should read as “4.3 µm.

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Sankaran, D., Zeinali, L., Iqbal, S. et al. Non-invasive carbon dioxide monitoring in neonates: methods, benefits, and pitfalls. J Perinatol 41, 2580–2589 (2021). https://doi.org/10.1038/s41372-021-01134-2

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