Carboxyhemoglobin – the forgotten parameter of neonatal hyperbilirubinemia

Douggl G.N. Bailey; Hans Fuchs; Roland Hentschel

doi:10.1515/jpm-2016-0053

Article

Carboxyhemoglobin – the forgotten parameter of neonatal hyperbilirubinemia

Douggl G.N. Bailey , Hans Fuchs and Roland Hentschel

Published/Copyright: January 18, 2017

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From the journal Journal of Perinatal Medicine Volume 45 Issue 5

Abstract

Background:

Neonatal hyperbilirubinemia is influenced by a wide variety of factors, one of which is hemolysis. Serious hyperbilirubinemia may lead to a kernicterus with detrimental neurologic sequelae. Patients suffering from hemolytic disease have a higher risk of developing kernicterus. Carbon monoxide (CO), a byproduct of hemolysis or heme degradation, was described by Sjöstrand in the 1960s. It is transported as carboxyhemoglobin (COHb) and exhaled through the lungs. We were interested in a potential correlation between COHb and total serum bilirubin (TSB) and the time course of both parameters.

Materials and methods:

We used a point of care (POC) blood gas analyzer and did a retrospective analysis of bilirubin and COHb data collected over a 60-day period.

Results:

An arbitrary cut-off point set at 2% COHb identified four patients with hemolytic disease of different origins who required phototherapy. In one patient with atypical hemolytic uremic syndrome (aHUS), COHb preceded the rise in bilirubin by about 2 days. Despite this displacement, there was a moderately good correlation of COHb with TSB levels <15 mg/dL (257 μmol/L) (r²: 0.80) and direct bilirubin (r²: 0.78) in the first patient. For all the four patients and all time points the correlation was slightly lower (r²: 0.59).

Conclusions:

COHb might be useful as a marker for high hemoglobin turnover to allow an earlier identification of newborns at risk to a rapid rise in bilirubin.

Keywords: Carbon monoxide; carboxyhemoglobin; hemolysis; neonatal hyperbilirubinemia; point of care testing

Author’s Statement
Conflict of interest: Authors state no conflict of interest.
Material and methods: Informed consent: Not required as this is a retrospective data analysis.
Ethical approval: Not required.

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Received: 2016-2-13

Accepted: 2016-11-29

Published Online: 2017-1-18

Published in Print: 2017-7-26

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Articles in the same Issue

https://doi.org/10.1515/jpm-2016-0053

Keywords for this article

Carbon monoxide; carboxyhemoglobin; hemolysis; neonatal hyperbilirubinemia; point of care testing