![]() The retrospective data collection was registered with the clinical governance department of King’s College Hospital NHS foundation trust for retrospective use of routinely recorded data on the medical and nursing charts. Written informed consent was given by parents for their infants to take part in the prospective study. ![]() Approval for the study was given by the London (Camden & King’s Cross) Research Ethics Committee (REC reference: 18/LO/1602). ![]() The first infant that fulfilled the matching criteria in reverse chronological order was selected as a matched control. Data were collected from 200 consecutively born infants admitted to the neonatal intensive care unit from 1/1/17 to 1/1/19, 36 infants from this sample were matched individually for gestational age and birth weight with the 36 infants prospectively recruited. Prospective data were collected from a cohort of ventilated infants in whom end-tidal CO 2 monitoring was used from to. Data were collected from a retrospective cohort of ventilated infants (historical controls) cared for in the NICU between and, prior to the addition of end-tidal CO 2 monitoring. The study was conducted on the neonatal intensive care unit at King’s College Hospital NHS Foundation Trust (KCH), London UK. We also aimed to determine whether use of sidestream capnography was associated with a reduction in severe intraventricular haemorrhage. We hypothesised that the introduction of sidestream capnography would reduce the magnitude of difference in CO 2 levels in mechanically ventilated newborns in the first week after birth and that the number of blood samples would be reduced. We recently reported on the performance of a novel microstream sidestream capnography device in ventilated newborns and found a good correlation of the results of that device with the gold standard mainstream capnograph. Mainstream or sidestream capnography can be used. Indeed, one study found the use of continuous capnography during the resuscitation of mechanically ventilated term lambs with meconium aspiration syndrome reduced the degree of the magnitude of difference in CO 2 levels. Use of capnography may, therefore, reduce large magnitude of difference in CO 2 levels. Capnography assesses breath by breath the exhaled carbon dioxide in real time and gives a continuous waveform together with the end-tidal CO 2 (EtCO 2) level. ![]() Non-invasive end-tidal carbon dioxide monitoring by capnography is an alternative method of assessing CO 2 levels. The Canadian Paediatric Society, Foetus and Newborn Committee recommend non-invasive CO 2 monitoring for ventilated, preterm infants to minimise blood loss and the need for multiple transfusions. Repeated blood sampling in neonates can lead to iatrogenic anaemia and the requirement for multiple blood transfusions, which are not without risks. Follow up of extremely preterm infants exposed to multiple heel prick tests in the neonatal period has shown that this can result in hyperalgesia and increased sensitivity to painful stimuli. MRI studies have found that early exposure to pain stress in preterm infants is associated with reduced white matter and subcortical brain matter maturation. ![]() Frequent blood sampling can also be painful for infants when there is no indwelling arterial catheter. Indwelling catheters in neonates can be associated with an increased risk of infection and thrombosis. This is the most accurate measurement of CO 2 levels, however, it is not without complications. The current gold standard for monitoring CO 2 levels in newborn infants is by arterial blood gas analysis. The recent European Consensus Guidelines recommend that clinicians should avoid abnormal levels of CO 2 by regular or continuous assessment of CO 2 levels. Furthermore, outcomes of term-born neonates exposed to high CO 2 variability during therapeutic hypothermia have been associated with adverse neurodevelopment at follow up. Disturbances in cerebral blood flow caused by the magnitude of difference in CO 2 levels and abnormalities in CO 2 levels can lead to intraventricular haemorrhage (IVH) and periventricular leukomalacia (PVL) and subsequent cerebral injury. Mechanical ventilation can be lifesaving for neonates, but long-term complications are increased in infants who have suffered abnormalities in carbon dioxide (CO 2) levels. ![]()
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