Non-invasive carbon dioxide monitoring in neonates: methods, benefits, and pitfalls

Wide fluctuations in partial pressure of carbon dioxide (PaCO(2)) can potentially be associated with neurological and lung injury in neonates. Blood gas measurement is the gold standard for assessing gas exchange but is intermittent, invasive, and contributes to iatrogenic blood loss. Non-invasive carbon dioxide (CO(2)) monitoring has become ubiquitous in anesthesia and critical care and is being increasingly used in neonates. Two common methods of non-invasive CO(2) monitoring are end-tidal and transcutaneous. A colorimetric CO(2) detector (a modified end-tidal CO(2) detector) is recommended by the International Liaison Committee on Resuscitation (ILCOR) and the American Academy of Pediatrics to confirm endotracheal tube placement. Continuous CO(2) monitoring is helpful in trending PaCO(2) in critically ill neonates on respiratory support and can potentially lead to early detection and minimization of fluctuations in PaCO(2). This review includes a description of the various types of CO(2) monitoring and their applications, benefits, and limitations in neonates.