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Is waveform capnography reliable in neonates?
  1. Alexandra Scrivens1,
  2. Sanja Zivanovic2,
  3. Charles Christoph Roehr2
  1. 1 Newborn Care Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
  2. 2 Department of Paediatrics, University of Oxford, Oxford, UK
  1. Correspondence to Dr Alexandra Scrivens, Newborn Care Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK ; alexandra.scrivens{at}

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You are the neonatal registrar on call for a level 3 neonatal intensive care unit (NICU). The mother of a baby born at 24 weeks’ gestation approaches you. Her son, who is now 7 days old, has been ventilated since birth. She has been reading the news and is concerned about an article which states that ‘sick babies [are] at risk from lack of breathing tube monitoring’.1 Her baby’s blood gasses, ventilator requirements and transcutaneous CO2 are all stable. You reassure her of this, but later read the news story and related survey by Foy et al 2 recommending that more neonatal units adopt waveform capnography. You wonder if waveform capnography offers a reliable approximation of partial pressure of carbon dioxide in arterial blood  (PaCO2).

Structured question

In neonates (infants <28 days of age) who require ventilation (population), does waveform capnography (intervention) give an accurate approximation of PaCO2 (outcome)?

Search strategy and outcome

MEDLINE was searched via PubMed using the search terms (neonat* OR newborn OR neonatal intensive care) AND capnography in August 2018. One hundred and forty-nine citations were obtained. Of these, 25 were felt to be potentially relevant. Titles and abstracts were reviewed and found 12 full-text papers, which were included. Further searches of reference lists found another 13 papers. One paper was excluded as it included infants who were not intubated. Studies that took place before 1990 were excluded due to the assumption that technologies have significantly advanced since then. Thus, 24 articles were examined: 14 articles with comparative data, 3 reviews, 3 surveys and 4 other studies. Included studies are shown in table 1 and discussed below. The levels of evidence were graded according to the Oxford Centre for Evidence Based Medicine levels of evidence.3

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Table 1

Outcomes of all studies, pCO2 expressed as mm Hg (=7.5 kPa), mean difference …

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  • Contributors CCR and AS devised the concept of the review. AS devised the draft manuscript. SZ and CCR contributed to the completion of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Not required.

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