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Original research
Exhaled CO2 monitoring to guide non-invasive ventilation at birth: a systematic review
  1. Vix Monnelly1,
  2. Justin B Josephsen2,
  3. Tetsuya Isayama3,
  4. Maria Fernanda B de Almeida4,
  5. Ruth Guinsburg4,
  6. Georg M Schmölzer5,
  7. Yacov Rabi6,
  8. Myra H Wyckoff7,
  9. Gary Weiner8,
  10. Helen G Liley9,
  11. Anne Lee Solevåg10
  1. 1 Department of Neonatology, Simpson Centre for Reproductive Health, Royal Infirmary of Edinburgh, Edinburgh, UK
  2. 2 Department of Pediatrics, Saint Louis University School of Medicine, St Louis, MO, USA
  3. 3 Division of Neonatology, Center of Maternal-Fetal Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
  4. 4 Division of Neonatal Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
  5. 5 Centre for the Studies of Asphyxia and Resuscitation and Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
  6. 6 Department of Pediatrics, University of Calgary and Alberta Children’s Hospital, Calgary, Alberta, Canada
  7. 7 Pediatrics, UT Southwestern Medical Center at Dallas, Dallas, Texas, USA
  8. 8 Department of Pediatrics, Neonatal-Perinatal Medicine, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA
  9. 9 Mater Research Institute, The University of Queensland, South Brisbane, QLD, Australia
  10. 10 Department of Neonatal Intensive Care, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
  1. Correspondence to Dr Anne Lee Solevåg, Department of Neonatal Intensive Care, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway; a.l.solevag{at}medisin.uio.no

Abstract

Objective Measuring exhaled carbon dioxide (ECO2) during non-invasive ventilation at birth may provide information about lung aeration. However, the International Liaison Committee on Resuscitation (ILCOR) only recommends ECO2 detection for confirming endotracheal tube placement. ILCOR has therefore prioritised a research question that needs to be urgently evaluated: ‘In newborn infants receiving intermittent positive pressure ventilation by any non-invasive interface at birth, does the use of an ECO2 monitor in addition to clinical assessment, pulse oximetry and/or ECG, compared with clinical assessment, pulse oximetry and/or ECG only, decrease endotracheal intubation in the delivery room, improve response to resuscitation, improve survival or reduce morbidity?’.

Design Systematic review of randomised and non-randomised studies identified by Ovid MEDLINE, Embase and Cochrane CENTRAL search until 1 August 2022.

Setting Delivery room.

Patients Newborn infants receiving non-invasive ventilation at birth.

Intervention ECO2 measurement plus routine assessment compared with routine assessment alone.

Main outcome measures Endotracheal intubation in the delivery room, response to resuscitation, survival and morbidity.

Results Among 2370 articles, 23 were included; however, none had a relevant control group. Although studies indicated that the absence of ECO2 may signify airway obstruction and ECO2 detection may precede a heart rate increase in adequately ventilated infants, they did not directly address the research question.

Conclusions Evidence to support the use of an ECO2 monitor to guide non-invasive positive pressure ventilation at birth is lacking. More research on the effectiveness of ECO2 measurement in addition to routine assessment during non-invasive ventilation of newborn infants at birth is needed.

PROSPERO registration number CRD42022344849.

  • neonatology
  • resuscitation

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

http://dx.doi.org/10.1136/archdischild-2023-325698

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    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplementary information.

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    Footnotes

    • Twitter @Research4Babies

    • Contributors VM: prepared the protocol, screened full-text articles, abstracted data, completed the analysis, made tables and wrote the manuscript. JBJ: prepared the protocol, screened full-text articles, abstracted data, completed the analysis and wrote the manuscript. TI: prepared the protocol. Main responsibility for methods including quality assessment; abstracted data, completed the analysis and edited the manuscript. MFBdA: prepared the protocol, screened the titles and abstracts, extracted the data on study designs, study population, interventions and outcomes, abstracted data, completed the analysis and edited the manuscript. RG: prepared the protocol, resolved conflicts in the screening of titles and abstracts, extracted the data on study designs, study population, interventions and outcomes, abstracted data, completed the analysis and edited the manuscript. GMS: reviewed the protocol, reviewed the analysis and edited the manuscript. YR: reviewed the protocol, reviewed the analysis and edited the manuscript. MHW: reviewed the protocol, reviewed the analysis and edited the manuscript. GW: reviewed the protocol, reviewed the analysis and edited the manuscript. HGL: reviewed the protocol, reviewed the analysis and edited the manuscript. ALS: prepared the protocol, screened the titles and abstracts, abstracted data, completed the analysis and wrote the manuscript. ALS is guarantor.

    • Funding The International Liaison Committee on Resuscitation provided support that included access to software platforms and teleconferencing.

    • Competing interests TI has been helping the company Nihon Koden to develop a respiratory function monitoring device for neonatal resuscitation. The respiratory function monitor does not have a CO2 detector. The other authors have no relevant competing interests.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.