The Journal of pediatrics · 2026
Validation of Continuous Transcutaneous Carbon Dioxide Monitoring in Neonates Undergoing Therapeutic Hypothermia for Neonatal Encephalopathy.
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Hannon Katie, Szakmar Eniko, Sunwoo John, Cherkerzian Sara, Kim Seh Hyun, Munster Chelsea, Garvey Aisling, El-Shibiny Hoda, Lee Sarah, Ben-David Danielle, Franceschini Maria Angela, Robinson Jill, Christou Helen, Inder Terrie, El-Dib Mohamed
Аннотация
OBJECTIVE: To assess the accuracy of transcutaneous carbon dioxide (tcPCO2) monitoring compared with intermittently sampled blood gas PCO2 in neonates undergoing therapeutic hypothermia (TH).
STUDY DESIGN: Neonates ≥34 weeks of gestation undergoing TH were enrolled and subsequently monitored with continuous tcPCO2. Agreement between tcPCO2 and both temperature-corrected and measured (uncorrected) blood gas PCO2 from arterial, venous, and capillary sources was assessed using Bland-Altman analyses that accounted for paired repeated measures.
RESULTS: One hundred thirty paired tcPCO2-PCO2 measurements were analyzed for 53 neonates. The mean difference (bias) between tcPCO2 and temperature-corrected PCO2 from all sources was 6.6 mm Hg with 95% limits of agreement from -7.4 to +20.6 mm Hg. Relative to measured PCO2, the geometric mean ratio indicated a 4% overestimation of tcPCO2, with proportional 95% limits of agreement from -25% to +35%. Capillary samples showed significant (P < .05) nonconstant variance in agreement with increasing variability at extreme PCO2 values, whereas arterial and venous samples demonstrated stable bias and variance across PCO2 ranges.
CONCLUSIONS: Using transcutaneous CO2 monitoring in infants with neonatal encephalopathy receiving TH, there is moderate agreement with wide 95% limits of agreement between tcPCO2 and PCO2 from all sources. Despite potential bias, tcPCO2 may assist in identifying trends and avoiding extreme PCO2 values during TH.
TRIAL REGISTRATION: https://clinicaltrials.gov/study/NCT04603547.
STUDY DESIGN: Neonates ≥34 weeks of gestation undergoing TH were enrolled and subsequently monitored with continuous tcPCO2. Agreement between tcPCO2 and both temperature-corrected and measured (uncorrected) blood gas PCO2 from arterial, venous, and capillary sources was assessed using Bland-Altman analyses that accounted for paired repeated measures.
RESULTS: One hundred thirty paired tcPCO2-PCO2 measurements were analyzed for 53 neonates. The mean difference (bias) between tcPCO2 and temperature-corrected PCO2 from all sources was 6.6 mm Hg with 95% limits of agreement from -7.4 to +20.6 mm Hg. Relative to measured PCO2, the geometric mean ratio indicated a 4% overestimation of tcPCO2, with proportional 95% limits of agreement from -25% to +35%. Capillary samples showed significant (P < .05) nonconstant variance in agreement with increasing variability at extreme PCO2 values, whereas arterial and venous samples demonstrated stable bias and variance across PCO2 ranges.
CONCLUSIONS: Using transcutaneous CO2 monitoring in infants with neonatal encephalopathy receiving TH, there is moderate agreement with wide 95% limits of agreement between tcPCO2 and PCO2 from all sources. Despite potential bias, tcPCO2 may assist in identifying trends and avoiding extreme PCO2 values during TH.
TRIAL REGISTRATION: https://clinicaltrials.gov/study/NCT04603547.