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The prediction of phototherapy by early postnatal ETCOc in Chinese newborns
Ge Yang1, Li Deng1, Kun Zhang1
1Division of Neonatology and Center for Newborn Care, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No. 9 Jinsui Road, Tianhe District, Guangzhou, Guangdong Province, 510623, China.
Insights
Early postnatal end-tidal carbon monoxide (ETCOc) levels predict the need for phototherapy in newborns with hyperbilirubinemia. Higher ETCOc indicates an increased risk and characteristics of phototherapy within 7 days of life.
Area of Science:
- Neonatal Medicine
- Pediatric Gastroenterology
- Clinical Chemistry
Background:
- The clinical significance of early postnatal end-tidal carbon monoxide (ETCOc) in predicting phototherapy (PT) for neonatal hyperbilirubinemia requires further characterization.
- Neonatal hyperbilirubinemia is a common condition requiring timely intervention to prevent complications.
Purpose of the Study:
- To investigate the relationship between early postnatal ETCOc and the risk of PT within 7 days of life (7 DOLs).
- To evaluate the diagnostic performance of ETCOc in predicting the need for PT.
Main Methods:
- Secondary analysis of infants from the HEME trial control group.
- Multivariate logistic regressions were used to analyze the association between ETCOc and PT, adjusting for relevant covariates.
- Diagnostic parameters including sensitivity, specificity, and predictive values were evaluated.
Main Results:
- Early postnatal ETCOc was significantly associated with an increased odds of PT (2.98-fold).
- Each one-unit increment in ETCOc correlated with earlier initiation, longer duration, and more courses of PT.
- ETCOc demonstrated a sensitivity of 65.4-87.5% and specificity of 71.7-75.8% for predicting PT, with AUCs ranging from 0.732-0.880.
Conclusions:
- Higher early postnatal ETCOc levels are linked to an increased risk and characteristics of PT within 7 DOLs.
- Early postnatal ETCOc serves as a valuable indicator for predicting PT in the early postnatal period.
Background:
The clinical significance of early postnatal ETCOc in the prediction of phototherapy (PT) for neonatal hyperbilirubinemia has not been fully characterized. We aimed to investigate the relationship between early postnatal ETCOc and the risk of PT within 7 days of life (7 DOLs) and diagnostic performance.
Methods:
This is a secondary analysis of the infants randomized to the control group of the HEME trial. Cases were infants who had PT within 7 DOLs and controls were infants who did not require PT. Multivariate logistic regressions were used for the analyses of phototherapy and early postnatal ETCOc, adjusting for transcutaneous bilirubin level, gestational age, birth weight, sex and maternal blood types. We also evaluated the predictive performance of ETCOc by comparing multiple diagnostic parameters.
Results:
In 1,219 infants included, early postnatal ETCOc was associated with 2.98-(95% confidence interval [CI] = 2.22, 4.00, < 0.01), 2.53-(95%CI = 1.65, 3.90, < 0.01) and 2.42(95%CI = 1.05, 5.61, < 0.01)-fold increased odds of PT, respectively. Each one-unit increment of ETCOc was associated with earlier initiation, longer duration and more courses of PT. The ETCOc had a sensitivity of 65.4-87.5%, specificity of 71.7-75.8%, positive predictive values of 41.0-51.6%, and negative predictive values of 87.3-95.3%, with area under curves of 0.732-0.880 for the outcome of PT.
Conclusions:
A higher early postnatal ETCOc is linked with an increased risk of PT and PT characteristics within 7 DOLs. Early postnatal ETCOc can be a valuable indicator for predicting PT in early postnatal period.
Trial Registration:
Registration identifier ChiCTR2100051476 of the Chinese Clinical Trial Registry ( https://www.chictr.org.cn/ ).
