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

Abstract

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