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

Abstract

BackgroundThe data is evolving on exhaled carbon dioxide (ECO2) levels for preterm infants requiring stabilisation. ObjectivesTo establish the trends of ECO2 levels during the first 10 minutes of stabilisation in preterm infants at birth. MethodsWe conducted a multi-centre, prospective observational study. We included all preterm infants ≤ 32 weeks needing stabilisation. We recorded blinded ECO2 using Masimo Rad-97TM Pulse oximeter with Capnography. We used the first 10 minutes of ECO2, 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. ResultsWe 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 kPa††1Kpa is equivalent to 7.501 mmHg; so, 3.042Kpa=22.82 mmHg. 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. ConclusionsWe 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.