Single breath CO measurements normalized to 5% CO2 in Coombs' test positive neonates

A portable, prototype instrument that measures peak CO, CO2 and H2 concentrations of breath samples was evaluated on 58 antibody positive, blood group incompatible infants. The reproducibility of 108 duplicate breath CO determinations improved when the result was normalized (CO(n)) for the simultaneously measured CO2 concentration (r = 0.97 versus r = 0.87). The average CO(n) for 18 antibody positive, ABO incompatible infants who received phototherapy was 1.2 ppm higher than the average for 32 who did not receive phototherapy (p < 0.001). There was a positive correlation between CO(n) and the duration of phototherapy (r = 0.75). Sodium acetate infusion and breath H2 did not affect the CO(n) results. In antibody positive infants, single breath CO to CO2 ratios provided more reproducible results than CO determinations that were not adjusted for the CO2 concentration. Therefore, a portable instrument that measures both gases on the same aliquot of exhaled air and that is not affected by H2 should have clinical utility as an indicator of heme catabolism and bilirubin production that is not distorted by hyper- or hypoventilation.