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Background <p>Hypocapnia and hypercapnia are associated with significant morbidity in preterm infants. Continuous transcutaneous CO₂ (tCO₂) monitoring may reduce pCO₂ fluctuations and blood sampling requirements.</p> Methods <p>A before-and-after study compared very low birth weight (VLBW) infants on high-frequency oscillatory ventilation (HFOV) before and after introducing tCO₂ monitoring. Primary outcomes were the incidences of hypercapnia (pCO₂ &gt; 60 mmHg) and hypocapnia (pCO₂ &lt; 40 mmHg) per day in HFOV. Secondary outcomes included the number of blood extractions per day and associations between tCO₂ monitoring and common neonatal morbidities.</p> Results <p>The pre-tCO₂ group comprised 28 patients and the tCO₂ group 50 patients. Baseline characteristics were comparable. The tCO₂ group showed reductions in hypocapnia: 1 (IQR 0.35–2) vs. 0.15 (IQR 0–0.5), <i>p</i> &lt; 0.01, and hypercapnia: 1.6 (IQR 0.87–2.6) vs. 0.5 (IQR 0.25–1), <i>p</i> &lt; 0.01, as well as fewer blood samples per day: 5 (IQR 3.5–7) vs. 3 (IQR 2.5–4), <i>p</i> &lt; 0.01. The tCO₂ group also showed a lower incidence of IVH, with no differences in mortality, transfusions, or other morbidities.</p> Conclusion <p>Continuous tCO₂ monitoring in VLBW infants on HFOV was associated with fewer episodes of hypo- and hypercapnia and reduced blood sampling. An association with lower IVH rates was observed; however, causality cannot be established.</p> Impact <p><UnorderedList Mark="Bullet"> <ItemContent> <p>This study evaluates the impact of transcutaneous CO₂ monitoring using a before-and-after design, analyzing its association with blood gas stability and neonatal outcomes.</p> </ItemContent> <ItemContent> <p>The use of transcutaneous CO₂ monitoring was associated with fewer episodes of hypocapnia and hypercapnia, as well as a reduced need for frequent blood sampling.</p> </ItemContent> <ItemContent> <p>A lower incidence of intraventricular hemorrhage was also observed in the group with transcutaneous CO₂ monitoring.</p> </ItemContent> <ItemContent> <p>These findings support the potential value of integrating continuous transcutaneous CO₂ monitoring into neonatal intensive care practices to enhance patient safety and reduce complications related to CO₂ fluctuations.</p> </ItemContent> </UnorderedList></p>

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Continuous transcutaneous CO2 monitoring in VLBW infants on high-frequency ventilation

  • 期刊论文

  • 发表日期：

    2025年12月17日

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  • Agustin Bernatzky,
  • Yanin Fontana Stiglich,
  • Maria Brandani,
  • Pablo Hernan Brener Dik,
  • Gonzalo Luis Mariani

摘要

Background

Hypocapnia and hypercapnia are associated with significant morbidity in preterm infants. Continuous transcutaneous CO₂ (tCO₂) monitoring may reduce pCO₂ fluctuations and blood sampling requirements.

Methods

A before-and-after study compared very low birth weight (VLBW) infants on high-frequency oscillatory ventilation (HFOV) before and after introducing tCO₂ monitoring. Primary outcomes were the incidences of hypercapnia (pCO₂ > 60 mmHg) and hypocapnia (pCO₂ < 40 mmHg) per day in HFOV. Secondary outcomes included the number of blood extractions per day and associations between tCO₂ monitoring and common neonatal morbidities.

Results

The pre-tCO₂ group comprised 28 patients and the tCO₂ group 50 patients. Baseline characteristics were comparable. The tCO₂ group showed reductions in hypocapnia: 1 (IQR 0.35–2) vs. 0.15 (IQR 0–0.5), p < 0.01, and hypercapnia: 1.6 (IQR 0.87–2.6) vs. 0.5 (IQR 0.25–1), p < 0.01, as well as fewer blood samples per day: 5 (IQR 3.5–7) vs. 3 (IQR 2.5–4), p < 0.01. The tCO₂ group also showed a lower incidence of IVH, with no differences in mortality, transfusions, or other morbidities.

Conclusion

Continuous tCO₂ monitoring in VLBW infants on HFOV was associated with fewer episodes of hypo- and hypercapnia and reduced blood sampling. An association with lower IVH rates was observed; however, causality cannot be established.

Impact

This study evaluates the impact of transcutaneous CO₂ monitoring using a before-and-after design, analyzing its association with blood gas stability and neonatal outcomes.

The use of transcutaneous CO₂ monitoring was associated with fewer episodes of hypocapnia and hypercapnia, as well as a reduced need for frequent blood sampling.

A lower incidence of intraventricular hemorrhage was also observed in the group with transcutaneous CO₂ monitoring.

These findings support the potential value of integrating continuous transcutaneous CO₂ monitoring into neonatal intensive care practices to enhance patient safety and reduce complications related to CO₂ fluctuations.