End-tidal carbon monoxide for routine monitoring of significant hemolysis in the management of newborn hyperbilirubinemia.

Objective: Assess the efficacy of routine ETCOc for all newborns in managing neonatal hyperbilirubinemia.

Study design: Retrospective chart review of 1029 consecutive well-baby nursery admissions following the 2022 AAP hyperbilirubinemia guidelines. Only ETCOc, not type, Rh, and DAT, was used to determine if significant hemolysis was present in sufficient degree to affect bilirubin management. A cost-benefit analysis comparing the two methods was conducted.

Result: 2.8% of infants required phototherapy, and 1.1% were readmitted for hyperbilirubinemia. The closer an infant's bilirubin level was to the phototherapy threshold, the higher the ETCOc. 12 of 29 DAT negative infants with ETCOc ≥ 2.5 PPM who received phototherapy would have gone home with significant hemolysis at risk for readmission or kernicterus if not for the use of ETCOc.

Conclusion: ETCOc is preferable for assessing significant hemolysis in the newborn, can be used to safely manage newborn hyperbilirubinemia, and results in cost savings.