Correlation between Non-invasive Measurement of Carboxyhemoglobin and Bilirubin Level Measurement in Near- Term and Term Neonates as a Predictor of Neonatal Hemolysis

Abstract

Abstract Background Neonatal hyperbilirubinemia is common in the neonatal period. Yet, serious pathological hyperbilirubinemia may cause kernicterus with detrimental neurologic sequalae. Carbon monoxide (CO) is the byproduct of the breakdown of heme, it is transported as carboxyhemoglobin to the lungs to be exhaled. Thus, carboxyhemoglobin levels increase as a result of hemolysis, and is therefore considered a sensitive index for the degree and severity of the subsequent hyperbilirubinemia. Objectives To correlate between non-invasive carboxyhemoglobin levels and bilirubin levels in near-term and tem neonates starting hour I of life. Subjects and methods A total of 100 near-term and term neonates were studied, by measuring carboxyhemoglobin by a Pulse CO-oximetry and serum bilirubin level (hour l) and transcutaneous bilirubin (TcB) hourly since birth for the I st 6 hours then every 6 hours till the time of discharge in a cross sectional case-control study. Results A cut off value of 4 for non-invasive carboxyhemoglobin with sensitivity of 81.25%, specificity of 95.24% was found to the earliest non-invasive predictor for subsequent jaundice. In patients with proven hemolysis, carboxyhemoglobin when compared to TcB was found to increase significantly in the first 3 hours of life more than TcB, stalting hour 4 till time of discharge it was increased yet statistically insignificant Conclusion We found that non-invasive carboxyhemoglobin is an effective early predictor for subsequent jaundice starting first hour of life. It can be used as a screening tool for hemolytic jaundice especially in hospitals with early discharge policy.