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Bahr TM, Shakib JH, Stipelman CH, Kawamoto K, Lauer S, Christensen RD. Improvement Initiative: End-Tidal Carbon Monoxide Measurement in Newborns Receiving Phototherapy. J Pediatr. 2021 Jul 11:S0022-3476(21)00673-9.

Objectives: To determine, as part of our Utah Newborn Nursery Bilirubin Management Program, whether end-tidal carbon monoxide concentration (ETCOc) measurements on all newborns in our nursery receiving phototherapy were associated with outcomes related to management of hyperbilirubinemia; including time (hours after birth) the phototherapy was initiated, total phototherapy duration during the nursery stay, repeat phototherapy treatments, and readmission to the hospital for phototherapy.

Study design: We performed a planned interim analysis of a component of our program where we measured ETCOc non-invasively using CoSense on every newborn in our nursery receiving phototherapy, recording specific outcomes related to phototherapy management.

Results: Of 1856 newborns admitted to our nursery over six months in 2020, 170 (9.8%) were treated with phototherapy. An ETCOc reading was successfully obtained from 145/151 (96%) of attempts. Higher ETCOc values were associated with earlier institution of phototherapy and longer phototherapy duration. For every 1 ppm increase in ETCOc, phototherapy was started 9 h earlier (95% CI, 3.3-14.8, p=0.002) and administered an additional 9.3 h (95% CI, 4.1-14.6, p<0.001). Three newborns were readmitted to the hospital for intensive phototherapy. While in the nursery all three had an elevated ETCOc (2.2, 2.6, and 2.9 ppm).

Conclusions: Our findings provide answers to questions raised in the 2004 AAP bilirubin guidelines. In our neonatal nursery, measuring ETCOc on all phototherapy recipients was feasible and safe and the results were associated with multiple aspects of phototherapy management. Higher ETCOc values predicted earlier and longer phototherapy courses.

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