ArticleNeonatology2020
Noninvasive Detection of Hemolysis with ETCOc Measurement in Neonates at Risk for Significant Hyperbilirubinemia.
Article in Neonatology, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers.
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Who cites it
14 citing papers in PubMed, 21 citations in OpenAlex.
- The prediction of phototherapy by early postnatal ETCOc in Chinese newborns.BMC pediatrics · 2025Trial
- End-tidal CO corrected for ambient CO risk adjusted phototherapy threshold for the management of neonatal hyperbilirubinemia: a randomized clinical trial.World journal of pediatrics : WJP · 2025Trial
- End tidal carbon monoxide and significant hemolysis.Journal of perinatology : official journal of the California Perinatal Association · 2026Review
- Can age-specific ETCOc determination predict the need for neonatal phototherapy?Pediatric research · 2026Article
- Bilirubin rate of rise during routine 6-h transcutaneous bilirubin surveillance.Journal of perinatology : official journal of the California Perinatal Association · 2026Article
- Age-specific ETCOc measured by non-dispersive infrared spectroscopy predicts neonatal phototherapy.Pediatric research · 2026Article
- Carboxyhemoglobin: a potential participant in neonatal hemolytic jaundice accompanied with myocardial injury.European journal of medical research · 2025Review
- Clinical superiority of artificial intelligence-enabled jaundice monitoring follow-up combined with end-tidal carbon monoxide measurement in neonatal jaundice management.American journal of translational research · 2025Article
- Erythrokinetic mechanism(s) causing the "late anemia" of hemolytic disease of the fetus and newborn.Journal of perinatology : official journal of the California Perinatal Association · 2024Review
- End-tidal carbon monoxide concentrations measured within 48 hours of birth predict hemolytic hyperbilirubinemia.Journal of perinatology : official journal of the California Perinatal Association · 2024Article
- A "Gold Standard" Test for Diagnosing and Quantifying Hemolysis in Neonates and Infants.Journal of perinatology : official journal of the California Perinatal Association · 2023Review
- Higher ETCOc predicts longer phototherapy treatment in neonatal hyperbilirubinemia.Frontiers in pediatrics · 2023Article
- Reference intervals for end-tidal carbon monoxide of preterm neonates.Journal of perinatology : official journal of the California Perinatal Association · 2022Article
- Breath Biomarkers in Diagnostic Applications.Molecules (Basel, Switzerland) · 2021Review
Corrections and comments
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Authors and funding
4 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundHemolytic hyperbilirubinemia due to blood group incompatibility or glucose-6-phosphate dehydrogenase deficiency (G6PD) is a common cause of significant hyperbilirubinemia. Hemolysis in a hyperbilirubinemic infant increases the risk of bilirubin neurotoxicity. A new portable device (CoSense) can rapidly detect breath end-tidal carbon monoxide corrected to ambient carbon monoxide (ETCOc). ETCOc levels are surrogate markers of hemoglobin breakdown and bilirubin production.
objectiveThe aim was to evaluate the association between ETCOc values and hemolysis and its relevance in neonates at risk for significant hyperbilirubinemia.
methodsA prospective study was conducted among newborn infants born at more than 35 weeks and with a birth weight greater than 2,000 g with a G6PD deficiency, blood group incompatibility, or clinical jaundice needing phototherapy during the first 7 days of life. The recruited infants had their breath ETCOc measured twice, first on the day of recruitment and then again on the following day.
resultsFifty infants completed this study. Their mean ETCOc was 1.61 (±0.56) ppm. There was a linear correlation (r = 0.89) between increasing ETCOc values and reticulocyte counts (RC). Sixteen newborns with ABO incompatibility had a significantly higher mean ETCOc of 1.98 ppm (±0.71) as compared to 1.43 (±0.38) ppm in the nonhemolytic hyperbilirubinemia (NHH) group (n = 25) (p = 0.002). This was suggestive of hemolysis as shown by the significantly higher RC of 6.90% (±3.38) compared to 4.68 (±1.26) in the NHH group (p <0.005). Neonates with an ETCOc level ≥1.8 ppm had a higher RC, a lower hemoglobin level, higher serum bilirubin levels, and a rapid rise in serum bilirubin and needed a longer duration of phototherapy. ETCOc values ≥1.8 ppm were suggestive of hemolysis (RC ≥6%), with a sensitivity of 90% and a specificity of 83%.
conclusionHigher ETCOc values ≥1.8 ppm are suggestive of hemolysis and they are associated with significant hyperbilirubinemia.
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