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PEDIATRICS Vol. 112 No. 6 December 2003, pp. 1333-1337

Corrected End-Tidal Carbon Monoxide Closely Correlates With the Corrected Reticulocyte Count in Coombs’ Test-Positive Term Neonates

Maria Cristina Javier, MD, Alfred Krauss, MD and Mirjana Nesin, MD

From the Division of Neonatology, Department of Pediatrics, Weill Medical College of Cornell University, New York, New York

Objective. To evaluate clinical usefulness of corrected end-tidal carbon monoxide (ETCOc) measurements in healthy, term, Coombs’ test-positive neonates and correlate it to the corrected reticulocyte count (RC).

Methods. ETCOc and RC were determined (at 36 ± 12 hours of age) in 50 Coombs’ test-positive neonates and compared with the ETCOc values of 50 Coombs’ test-negative neonates.

Results. Fifty percent of Coombs’ test-positive infants had RCs <5% (within a normal range for a healthy newborn) and ETCOc = 1.8 ± 0.34 parts per million (ppm) and likely did not exhibit hemolysis. Among infants with elevated RCs, 72% had RCs between 5% and 8% and ETCOc = 2.77 ± 0.68 ppm, and 28% had RCs >8% and ETCOc = 4.52 ± 0.83 ppm. There was an almost linear correlation (r = 0.86) between the RC and the ETCOc among Coombs’ test-positive infants. The 50 Coombs’ test-negative infants had ETCOc = 1.6 ± 0.45 ppm. Serial ETCOc measurements were performed in 14 Coombs’ test-positive infants: in all but 1 infant ETCOc values declined over time.

Conclusions. There is a good correlation between ETCOc and RC in Coombs’ test-positive infants. ETCOc >2.5 ppm predicts a significant elevation of RC in 90% of Coombs’ test-positive infants.

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Key Words: end-tidal carbon monoxide • reticulocyte count • infants • Coombs test

Abbreviations: RC, reticulocyte count • CO, carbon monoxide • ETCO, end-tidal CO • ETCOc, corrected ETCO • ppm, parts per million • ROC, receiver operator curve

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Received for publication Aug 21, 2002; Accepted Mar 7, 2003.

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