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Objective <p>Compare the direct antiglobulin test (DAT) versus end-tidal carbon monoxide (ETCOc) to predict significant hyperbilirubinemia.</p> Study Design <p>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).</p> Results <p>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%).</p> Conclusion <p>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.</p>

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Assessing risk for hemolytic hyperbilirubinemia in newborns: direct antiglobulin test versus end-tidal carbon monoxide

  • 期刊论文

  • 发表日期：

    2026年6月29日

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  • Juniper L. Burch,
  • Ann Cheung,
  • Nora K. Horick,
  • Leela Sarathy

摘要

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.