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Delivery room end tidal CO2 monitoring in preterm infants <32 weeks
  1. Gavin A Hawkes1,2,3,
  2. Mmoloki Kenosi1,2,3,
  3. Daragh Finn3,
  4. John M O'Toole1,2,
  5. Ken D O'Halloran4,
  6. Geraldine B Boylan1,2,
  7. Anthony C Ryan1,2,3,
  8. Eugene M Dempsey1,2,3
  1. 1Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
  2. 2Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland
  3. 3Department of Neonatology, Cork University Maternity Hospital, Cork, Ireland
  4. 4Department of Physiology, School of Medicine, University College Cork, Cork, Ireland
  1. Correspondence to Professor Eugene M Dempsey, Department of Neonatology, Cork University Maternity Hospital, T12 YE02, Ireland; g.dempsey{at}ucc.ie

Abstract

Objectives To determine the feasibility of end tidal (EtCO2) monitoring of preterm infants in the delivery room, to determine EtCO2 levels during delivery room stabilisation, and to examine the incidence of normocapnia (5–8 kPa) on admission to the neonatal intensive care unit in the EtCO2 monitored group compared with a historical cohort without EtCO2 monitoring.

Patients and methods Preterm infants (<32 weeks) were eligible for inclusion in this observational study. The evolution of EtCO2 values immediately after delivery was assessed and linear least-squares methods were used to fit a line to EtCO2 recordings. The partial pressure of CO2 in blood (PCO2) from the infants who received EtCO2 monitoring was compared with a historical cohort without EtCO2 monitoring.

Results EtCO2 monitoring was feasible in the delivery room. EtCO2 values were successfully obtained in 39 (88.7%) of the 44 infants included in the study. EtCO2 gradually increased over the first 4 min. Intubated infants had higher EtCO2 values compared with infants who were not intubated, with median (IQR) values of 4.7 (3.3–8.4) kPa versus 3.2 (2.6–4.2) kPa (p=0.05). No difference was found between the proportions of PCO2 values within the range of normocapnia among infants who received EtCO2 monitoring compared with those who did not (56.8% vs 47.9%, p=0.396).

Conclusions Delivery room EtCO2 monitoring is feasible and safe. EtCO2 values obtained after birth reflect the establishment of functional residual capacity and effective ventilation. The potential short-term and long-term consequences of EtCO2 monitoring should be established in randomised controlled trials.

  • Neonatology
  • Resuscitation
  • Respiratory

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