End-tidal carbon dioxide levels during resuscitation and carbon dioxide levels in the immediate neonatal period and intraventricular haemorrhage

Abnormal levels of end-tidal carbon dioxide (EtCO(2)) during resuscitation in the delivery suite are associated with intraventricular haemorrhage (IVH) development. Our aim was to determine whether carbon dioxide (CO(2)) levels in the first 3 days after birth reflected abnormal EtCO(2) levels in the delivery suite, and hence, a prolonged rather than an early insult resulted in IVH. In addition, we determined if greater EtCO(2)level fluctuations during resuscitation occurred in infants who developed IVH. EtCO(2) levels during delivery suite resuscitation and CO(2) levels on the neonatal unit were evaluated in 58 infants (median gestational age 27.3 weeks). Delta EtCO(2) was the difference between the highest and lowest level of EtCO(2). Thirteen infants developed a grade 3–4 IVH (severe group). There were no significant differences in CO(2) levels between those who did and did not develop an IVH (or severe IVH) on the NICU. The delta EtCO(2) during resuscitation differed between infants with any IVH (6.2 (5.4–7.5) kPa) or no IVH (3.8 (2.7–4.3) kPA) (p < 0.001) after adjusting for differences in gestational age. Delta EtCO(2) levels gave an area under the ROC curve of 0.940 for prediction of IVH. Conclusion: The results emphasize the importance of monitoring EtCO(2) levels in the delivery suite.