Carbon dioxide monitoring during neonatal stabilisation at delivery (COSTA-Neo)-Multi centre observational study

Prakash Kannan Loganathan; Imran Ahmed; Nitesh Singh; Emily Baker; Difu Shi; Carlton Baugh

doi:10.1016/j.resuscitation.2023.110026

Carbon dioxide monitoring during neonatal stabilisation at delivery (COSTA-Neo)-Multi centre observational study

Resuscitation. 2023 Oct 27:110026. doi: 10.1016/j.resuscitation.2023.110026. Online ahead of print.

Authors

Prakash Kannan Loganathan¹, Imran Ahmed², Nitesh Singh³, Emily Baker⁴, Difu Shi⁴, Carlton Baugh⁴

Affiliations

¹ Neonatal Unit, James Cook University Hospital, Middlesbrough, United Kingdom; Clinical Academic Office, Faculty of Medical Sciences, Newcastle University, United Kingdom; Institute for Computational Cosmology, Department of Physics, University of Durham, Durham, DH1 3LE, United Kingdom. Electronic address: [email protected].
² Neonatal Unit, Sunderland Royal Hospital, Sunderland, United Kingdom.
³ Neonatal Unit, University Hospitals Coventry and Warwickshire, Coventry, United Kingdom.
⁴ Institute for Computational Cosmology, Department of Physics, University of Durham, Durham, DH1 3LE, United Kingdom.

PMID: 39491085
DOI: 10.1016/j.resuscitation.2023.110026

Abstract

Background: The data is evolving on exhaled carbon dioxide (ECO₂) levels for preterm infants requiring stabilisation.

Objectives: To establish the trends of ECO₂ levels during the first 10 minutes of stabilisation in preterm infants at birth.

Methods: We conducted a multi-centre, prospective observational study. We included all preterm infants ≤ 32 weeks needing stabilisation. We recorded blinded ECO₂ using Masimo Rad-97^TM Pulse oximeter with Capnography. We used the first 10 minutes of ECO_2, pulse rate (PR) and oxygen saturation (SpO₂) data from pulse oximeter for our analysis. We collected stabilisation and clinical details. Ethics approval and informed consent was obtained.

Results: We recruited 150 preterm infants, with data of 131 babies available for analysis. Median (and interquartile range) birth gestational age and birth weight were 28 (26.5 - 30) weeks and 1110 (800- 1422.5) grams. All infants received positive end expiratory pressure (PEEP). In addition, 91 (69%) received positive pressure inflations, 34 (26%) received only PEEP and 34 (26%) were intubated within the first 10 minutes of life. Using bootstrapping, the 50% confidence interval for ECO₂ at 5 minutes was estimated to range from 3.042 kPa¹ to 3.328 kPa and has minimal change after 5 minutes. ECO₂ appeared earlier than any valid PR and SpO₂ data with median time difference of 16 (2-22) s) and 14 (0-20) s respectively.

Conclusions: We have provided trends of ECO₂ in preterm infants needing stabilisation during the first 10 minutes of life. ECO₂ appeared at least as early as any valid PR and earlier than SpO₂.

Keywords: Exhaled carbon dioxide; preterm resuscitation; preterm stabilisation.