Because end-tidal carbon monoxide corrected for ambient carbon monoxide (ETCOc) is a reliable indicator of bilirubinBilirubin A yellow substance produced when red blood cells break down. High bilirubin levels in newborns with HDFN can cause jaundice or, in severe cases, brain damage. production, it can be used as a noninvasive biomarker to identify the early breakdown of red blood cells and alert doctors to the potential risk of hemolytic disease of the fetus and newborn (HDFN) among newborn infants, according to a study recently published in Clinica Chimica Acta.
Infants born with HDFN usually have high levels of hemolysis, which causes the breakdown of red blood cells. This occurs as a result of maternal antibodiesAntibody A protein made by the immune system that recognizes and attacks foreign substances, such as bacteria, or in HDFN, fetal red blood cells carrying incompatible antigens. mistakenly attacking the fetal red blood cells during pregnancy. As a result of hemolysis, bilirubin levels increase.
Scientists have known that raised ETCOc is linked to hemolysis, but this information has not been applied to the monitoring and management of HDFN. The study’s researchers sought to study any association between early newborn ETCOc measurements and the risk of developing HDFN.
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The research team conducted a secondary analysis of a clinical trial that included newborns who were born at term or near-term, defined as infants born at 35 weeks of gestation or later. These infants must also have a birth weight of 2000g or more, with transcutaneous (ie, measured across the skin) bilirubin levels within 72 hours of life being higher than the 40th percentile expected in healthy infants. Researchers then compared findings among infants diagnosed with HDFN and those who were not.
Researchers looked into the clinical records of 2,500 infants, only 171 (6.8%) of whom were diagnosed with HDFN. They found that ETCOc levels measured within the first 72 hours of life were significantly higher among infants with HDFN compared with healthy infants. An increase in ETCOc was clearly associated with increased odds of developing HDFN early in life.
The strong association between ETCOc and the risk of developing HDFN means that doctors can use ETCOc as a noninvasive biomarker to identify infants at risk of hemolysis as a result of HDFN. This gives doctors more room to make accurate risk assessments and decide on appropriate treatment in a timely manner.
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