Accuracy of Transcutaneous Carbon Dioxide Measurement in Premature Infants

Background. In premature infants, maintaining blood partial pressure of carbon dioxide (pCO(2)) value within a narrow range is important to avoid cerebral lesions. The aim of this study was to assess the accuracy of a noninvasive transcutaneous method (TcpCO(2)), compared to blood partial pressure of carbon dioxide (pCO(2)). Methods. Retrospective observational study in a tertiary neonatal intensive care unit. We analyzed the correlation between blood pCO(2) and transcutaneous values and the accuracy between the trends of blood pCO(2) and TcpCO(2) in all consecutive premature infants born at < 33 weeks' gestational age. Results. 248 infants were included (median gestational age: 29 + 5 weeks and median birth weight: 1250 g), providing 1365 pairs of TcpCO(2) and blood pCO(2) values. Pearson's R correlation between these values was 0.58. The mean bias was -0.93 kPa with a 95% confidence limit of agreement of -4.05 to + 2.16 kPa. Correlation between the trends of TcpCO(2) and blood pCO(2) values was good in only 39.6%. Conclusions. In premature infants, TcpCO(2) was poorly correlated to blood pCO(2), with a wide limit of agreement. Furthermore, concordance between trends was equally low. We warn about clinical decision-making on TcpCO(2) alone when used as continuous monitoring.