Evaluat?on Of A New Transcutaneous Measurement Of Pco2 Sensor In Newborns In Del?very Room

摘要

The intrapartum acid-base status of the fetus is an important parameter to establish the relation between intrapartum events. Respiratory acidosis is the beginning event after intrapartum asphyxia. If the asphyxia continues metabolic acidosis developes and complicates the delivery (1). During the respiratory acidosis phase pCO2 can be an important parameter.Noninvasive monitoring of pCO2 and oxygen saturation (SpO2 ) can give idea about intrapartum and respiratory status of the newborn infant. Aim To evaluate the relation between SpO2, pulse rate (PR) and transcutaneous measerement of pCO2 ( TcPCO2 ) in healthy term infants immediately after birth in delivery room . Methods In a prospective, nonrandomized study of 20 healthy term infants of uneventfull pregnancies born vaginally with good apgar scores the new sensor for combined TcPCO2 , pulse rate (PR) and SpO2 was tested.The V-Sign? Sensor is a digital sensor for noninvasive and continuous monitoring of TcPCO2, SpO2 and PR. It combines the elements of a Stow-Severinghaus type pCO2 sensor and a pulse oximetry sensor (SenTec AG, Therwil, Switzerland ). For each baby one seperate sensor was applied by a pediatric resident after drying the baby and the values of SpO2, PR and TcPCO2 were recorded by a neonatologist at 5th, 10th and 15th minutes of birth in the delivery room. The temperature and perfusion of the skin of the infants where the sensor was applied did not change during the study. The study was completed without any complication. Data were analyzed by using SPSS-16 version programme. Results Fourteen infants were male, 6 were females. Mean birth weight of infants was 3351gr( 2580-4220 ). Mean Rates of Parameters at 5-10-15th minutes were shown in Table 1.5th minute TcPCO2 value was highly correlated with PR at 5th and 10th minutes (p=0.004). TcPCO2 at 5th minute was not correlated with SpO2 at 5th minute (p=0.2). However 5th minute SpO2 value has no correlation with 5th minute PR (p=0.6) which shows that TcPCO2 mesurement was more sensitive than SpO2 measurement. Discussion Non-invasive methods of . CO2 monitoring are by transcutaneous and endotracheal end tidal measurements which are used in neonatal intensive care and during transport of critical patients ( 2 ). Recently, a new sensor ( TOSCA ) for combined assessment of pulse oximetry oxygen saturation and . TcPCO2 has been used in a prospective sudy of ill neonates including preterm babies. According to that study new monitor allows reliable noninvasive estimation of SpO2 and TcPCO2 in neonates. They used ear lobe sensor clips ( 3 ). In present study we used another sensor in neonates in delivery room. In pediatric cardiology during heart operation mesurement of TcPCO2 can give an idea about the type of acidosis (4). In a recent study by Tobias JD use of TcPCO2 even in diabetic ketoacidosis is mentioned (5). The same logic worked in the present study. Conclusion Early measurement of TcPCO2 value is more sensitive than SpO2 value to determine the neonatal condition in delivery room. TcPCO2 can be used to measure intrapartum status of the newborn and comparing TcPCO2 with that of umbilical cord may be subject of another study.