Resident Sidney Kimmel Medical College at Thomas Jefferson University Philadelphia, Pennsylvania, United States
Background: Hyperbilirubinemia is a common condition in newborns with isoimmunization being a major predisposing factor. DAT is a screening test used to assess if antibodies are attached to the RBCs which can lead to cellular destruction and immune hemolytic anemia. Significant hemolysis is a known risk factor for bilirubin induced neurological damage, and its presence lowers the recommended threshold for initiation of phototherapy.
While DAT screening has been widely used to assess for hemolytic disease of the newborn (HDN), multiple studies have shown that DAT+ is often not associated with significant hemolysis and did not predict the severity of neonatal hyperbilirubinemia. End-tidal carbon monoxide (ETCO) is a much more specific measure of hemolysis, and it can be easily and non-invasively measured via the CoSense ETCO monitor on an infant’s exhaled breath. Objective: Compare the use of ETCO vs Type, Rh, and DAT in the management of neonatal hyperbilirubinemia. Design/Methods: Data was collected from two groups of 1000 infants each on the post-partum unit. The before group were infants born in 2022 prior to ETCO routinely being implemented. The after group were infants born in 2023 with ETCO being routinely collected on every infant on the unit. Only ETCO, not type, Rh, and DAT, was used to determine if significant hemolysis was present in sufficient degree to affect bilirubin management. The percentage of infants in each group requiring phototherapy, as well as readmission for phototherapy, was compared. The percentage of DAT negative infants with elevated ETCO (≥2.5 ppm) was determined. A cost-benefit analysis comparing the two methods was also conducted. This study was approved by the institutional IRB (Approval # 2023-1055).
