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Jaundice is a highly prevalent condition.

9 million babies are born in the US and Europe each year.1 60-80% of these babies will develop jaundice.2,3

  • In many babies, this is a normal condition that can be easily treated.
  • Babies with both HYPERBILIRUBINEMIA and HEMOLYSIS are at greatest risk for adverse neurodevelopmental outcomes.4
  • HOWEVER, in some newborns, jaundice is not normal and is caused by an underlying HEMOLYTIC CONDITION.
  • Untreated jaundice has a range of clinical and financial impacts for patients and hospitals.
  • According to the AAP Guidelines, newborns with a hemolytic condition need to receive phototherapy at lower levels of bilirubin than other newborns.5

Since 2004, the American Academy of Pediatrics has recommended the use of ETCO testing.

AAP Guidelines recommend the use of ETCO testing in newborns 35 weeks’ gestation or more who:5

1. are receiving phototherapy, or
2. have TSB rising rapidly, or
3. have TSB approaching transfusion levels, or
4. have jaundice unexplained by history and physical.

Published data show that ETCO testing, unlike blood tests, provides an accurate measure of hemolysis.6

The American Academy of Pediatrics (AAP) has recommended the use of ETCO to directly measure bilirubin production rates in newborns.5 Multiple clinical trials have validated the ability of the CoSense ETCO Monitor to measure ETCO, which may be used to detect the rate of hemolysis in newborns.7,8
1. Eurostat. Number of Live Births in 2012 ( EU27 ),http://epp.eurostat.ec.europa.eutgm/table.do?tab=table&init=1&plugin=1&language=en&pcode=tps00111 ; US Department of Health and Human Services. National Vital Statistics Reports,Births Final Data for 2012. December 30,2013,http://www.cdc. gov/nchs/data/nvsr/ nvsr62/nvsr62_09.pdf#table01.

2.Bhutani VK,Johnson L. A proposal to prevent severe neonatal hyperbilirubinemia and kernicterus. J Perinatol. 2009;29 Suppl 1:S61-S67.

3.Kumar RK. Neonatal jaundice. An update for family physicians. Aust Fam Physician. 1999;28:679-682.

4.Kuzniewicz M,Newman TB. Interaction of hemolysis and hyperbilirubinemia on neurodevelopmental outcomes in the collaborative perinatal project. Pediatrics. 2009;123:1045-1050.

5.Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics. 2004;114:297-316, p. 297, 300, 303, 306.

6.Stevenson DK,Vreman HJ,Oh W et al. Bilirubin production in healthy term infants as measured by carbon monoxide in breath. Clin Chem. 1994;40:1934-1939.

7.Castillo Cuadrado ME,Vreman HJ,Wong RJ,Stevenson DK,Bhutani VK. From bench to bedside: evaluation of a new end-tidal carbon monoxide monitor to identify hemolysis in infants. Acta Paediatr. 2015 Jun;104 ( 6 ):e279-82. doi:10.1111/apa.12938.

8.Du L,Zou P,Chen L,and Bhutani V. Exhaled end-tidal carbon monoxide testing for hemolysis in neonates with significant hyperbilirubinemia and postive direct anti-globulin test. Poster presentation at Pediatrics Academic Societies Meeting,May 6,2014.

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