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Am J Perinatol 2017; 34(05): 480-485
DOI: 10.1055/s-0036-1593352
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Transcutaneous Carbon Dioxide Monitoring with Reduced-Temperature Probes in Very Low Birth Weight Infants

Safwat Aly
1   Department of Pediatrics, Children's National Medical Center, The George Washington University, Washington, District of Columbia
,
Mohamed El-Dib
2   Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts
,
Mohamed Mohamed
3   Division of Newborn Services, Children's National Medical Center, The George Washington University, Washington, District of Columbia
,
Hany Aly
3   Division of Newborn Services, Children's National Medical Center, The George Washington University, Washington, District of Columbia
› Author Affiliations
Further Information

Publication History

16 June 2016

19 August 2016

Publication Date:
27 September 2016 (online)

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Abstract

Background Obtaining blood gases in very low birth weight (VLBW) infants is an invasive procedure. Studies using transcutaneous carbon dioxide (tcPCO2) have reported variable skin complications with high-temperature probes. No enough data available on tcPCO2 monitoring using reduced-temperature probes (41°C).

Objective The objective of this study was to assess reliability and safety of tcPCO2 monitoring at reduced-temperature probe in VLBW infants.

Design and Methods A prospective study was conducted on VLBW infants. tcPCO2 was monitored for 12 hours. Default skin probe temperature was adjusted at 41°C. Blood gases were done as clinically indicated. Arterial partial pressure of CO2 (PaCO2) as well as capillary CO2 were compared with simultaneous tcPCO2.

Results A total of 124 data points were identified from 50 patients (gestational age [GA] = 28.1 ± 2.4 weeks and birth weight [BW] = 1,035 ± 291 g). Patients were supported with continuous positive airway pressure (40%), noninvasive positive pressure ventilation (16%), mechanical ventilation (18%), and high-frequency oscillation ventilation (24%). PaCO2 was measured using either capillary (58%) or arterial (42%) samples. Mean CO2 did not differ between tcPCO2 (51.3 ± 16) and PaCO2 (49.1 ± 13.7) mm Hg. tcPCO2 showed positive correlation with partial pressure of CO2 (r = 0.6, p < 0.001). This correlation continued to be significant after controlling for GA, postmenstrual age, type of sample, and pH. No skin complications were reported.

Conclusion tcPCO2 monitoring using a temperature of 41°C is feasible and reliable in VLBW infants.

Keywords

transcutaneous carbon dioxide - VLBW - premature infants - blood gas
 

  • References

  • 1 Garland JS, Buck RK, Allred EN, Leviton A. Hypocarbia before surfactant therapy appears to increase bronchopulmonary dysplasia risk in infants with respiratory distress syndrome. Arch Pediatr Adolesc Med 1995; 149 (6) 617-622
    CrossrefPubMedGoogle Scholar
  • 2 Fujimoto S, Togari H, Yamaguchi N, Mizutani F, Suzuki S, Sobajima H. Hypocarbia and cystic periventricular leukomalacia in premature infants. Arch Dis Child 1994; 71 (2) F107-F110
    CrossrefPubMedGoogle Scholar
  • 3 Molloy EJ, Deakins K. Are carbon dioxide detectors useful in neonates?. Arch Dis Child Fetal Neonatal Ed 2006; 91 (4) F295-F298
    CrossrefPubMedGoogle Scholar
  • 4 Bernet-Buettiker V, Ugarte MJ, Frey B, Hug MI, Baenziger O, Weiss M. Evaluation of a new combined transcutaneous measurement of PCO2/pulse oximetry oxygen saturation ear sensor in newborn patients. Pediatrics 2005; 115 (1) e64-e68
    CrossrefPubMedGoogle Scholar
  • 5 Hermansen MC, Hermansen MG. Intravascular catheter complications in the neonatal intensive care unit. Clin Perinatol 2005; 32 (1) 141-156 , vii
    CrossrefPubMedGoogle Scholar
  • 6 Eberhard P. The design, use, and results of transcutaneous carbon dioxide analysis: current and future directions. Anesth Analg 2007; 105 (6, Suppl): S48-S52
    CrossrefPubMedGoogle Scholar
  • 7 Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986; 1 (8476): 307-310
    PubMedGoogle Scholar
  • 8 Aliwalas LL, Noble L, Nesbitt K, Fallah S, Shah V, Shah PS. Agreement of carbon dioxide levels measured by arterial, transcutaneous and end tidal methods in preterm infants < or = 28 weeks gestation. J Perinatol 2005; 25 (1) 26-29
    CrossrefPubMedGoogle Scholar
  • 9 Sørensen LC, Brage-Andersen L, Greisen G. Effects of the transcutaneous electrode temperature on the accuracy of transcutaneous carbon dioxide tension. Scand J Clin Lab Invest 2011; 71 (7) 548-552
    CrossrefPubMedGoogle Scholar
  • 10 Hirata K, Nishihara M, Oshima Y, Hirano S, Kitajima H. Application of transcutaneous carbon dioxide tension monitoring with low electrode temperatures in premature infants in the early postnatal period. Am J Perinatol 2014; 31 (5) 435-440
    Article in Thieme ConnectPubMedGoogle Scholar
  • 11 Schultz MJ, de Kleine MJ, Koppe JG. Transcutaneous PCO2 determination in neonatology [in Dutch]. Tijdschr Kindergeneeskd 1991; 59 (2) 44-50
    PubMedGoogle Scholar
  • 12 Fitzgerald M. The development of nociceptive circuits. Nat Rev Neurosci 2005; 6 (7) 507-520
    CrossrefPubMedGoogle Scholar
  • 13 Slater L, Asmerom Y, Boskovic DS , et al. Procedural pain and oxidative stress in premature neonates. J Pain 2012; 13 (6) 590-597
    CrossrefPubMedGoogle Scholar
  • 14 Smith GC, Gutovich J, Smyser C , et al. Neonatal intensive care unit stress is associated with brain development in preterm infants. Ann Neurol 2011; 70 (4) 541-549
    CrossrefPubMedGoogle Scholar
  • 15 American Academy of Pediatrics; Committee on Fetus and Newborn; Canadian Paediatric Society; Fetus and Newborn Committee. Prevention and management of pain in the neonate. An update. Adv Neonatal Care 2007; 7 (3) 151-160
    CrossrefPubMedGoogle Scholar
  • 16 Berkenbosch JW, Tobias JD. Transcutaneous carbon dioxide monitoring during high-frequency oscillatory ventilation in infants and children. Crit Care Med 2002; 30 (5) 1024-1027
    CrossrefPubMedGoogle Scholar