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Updated: Jul 1, 2026
Biochemical Measurement of Neonatal Hypoxia
Published on: August 24, 2011
Assessing risk for hemolytic hyperbilirubinemia in newborns: direct antiglobulin test versus end-tidal carbon
Juniper L Burch1, Ann Cheung2, Nora K Horick3
1Division of Newborn Medicine, Mass General Brigham for Children, Boston, MA, USA. jlburch@mgb.org.
Objective:
Compare the direct antiglobulin test (DAT) versus end-tidal carbon monoxide (ETCOc) to predict significant hyperbilirubinemia.
Study Design:
Prospective review of a convenience sample of 151 newborns admitted to the newborn nursery who had ETCOc testing in addition to standard of care (including DAT for those with ABO incompatibility).
Results:
The optimal ETCOc cutoff to predict a serum bilirubin meeting the neurotoxicity risk phototherapy threshold was 2.1 ppm. DAT had a sensitivity of 13% with specificity of 89% and ETCOc ≥ 2.1 ppm had a sensitivity of 88% with specificity of 68% to predict this outcome. Use of ETCOc ≥ 2.1 ppm rather than DAT to determine neurotoxicity risk increased indications for serum bilirubin testing (25% versus 18%) and phototherapy (8% versus 1%).
Conclusion:
ETCOc ≥ 2.1 ppm had higher sensitivity but lower specificity than DAT to predict hyperbilirubinemia and resulted in increased indications for serum bilirubin testing and phototherapy.
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