{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T10:45:47Z","timestamp":1784630747987,"version":"3.55.0"},"reference-count":30,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2023,9,4]],"date-time":"2023-09-04T00:00:00Z","timestamp":1693785600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Extremely low birth weight (ELBW) premature infants are particularly susceptible to hypocarbia and hypercarbia, which are associated with brain and lung morbidities. Transcutaneous CO2 (TcCO2) monitoring allows for continuous non-invasive CO2 monitoring during invasive and non-invasive ventilation and is becoming more popular in the NICU. We aimed to evaluate the correlation and agreement between CO2 levels measured by a TcCO2 monitor and blood gas CO2 (bgCO2) among ELBW infants. This was a prospective observational multicenter study. All infants &lt; 1000 g admitted to the participating NICUs during the study period were monitored by a TcCO2 monitor, if available. For each bgCO2 measured, a simultaneous TcCO2 measurement was documented. In total, 1828 pairs of TcCO2\u2013bgCO2 values of 94 infants were collected, with a median (IQR) gestational age of 26.4 (26.0, 28.3) weeks and birth weight of 800 (702, 900) g. A moderate correlation (Pearson: r = 0.64) and good agreement (bias (95% limits of agreement)):(2.9 [\u221211.8, 17.6] mmHg) were found between the TcCO2 and bgCO2 values in the 25\u201370 mmHg TcCO2 range. The correlation between the TcCO2 and bgCO2 trends was moderate. CO2 measurements by TcCO2 are in good agreement (bias &lt; 5 mmHg) with bgCO2 among premature infants &lt; 1000 g during the first week of life, regardless of day of life, ventilation mode (invasive\/non-invasive), and sampling method (arterial\/capillary\/venous). However, wide limits of agreement and moderate correlation dictate the use of TcCO2 as a complementary tool to blood gas sampling, to assess CO2 levels and trends in individual patients.<\/jats:p>","DOI":"10.3390\/jcm12175757","type":"journal-article","created":{"date-parts":[[2023,9,4]],"date-time":"2023-09-04T10:24:30Z","timestamp":1693823070000},"page":"5757","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Transcutaneous CO2 Monitoring in Extremely Low Birth Weight Premature Infants"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9949-4308","authenticated-orcid":false,"given":"Liron","family":"Borenstein-Levin","sequence":"first","affiliation":[{"name":"Department of Neonatology, Rambam Health Care Campus, Haifa 3109601, Israel"},{"name":"Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200003, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noa","family":"Avishay","sequence":"additional","affiliation":[{"name":"Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200003, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-8427-3316","authenticated-orcid":false,"given":"Orit","family":"Soffer","sequence":"additional","affiliation":[{"name":"Department of Neonatology, Rambam Health Care Campus, Haifa 3109601, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6765-1583","authenticated-orcid":false,"given":"Shmuel","family":"Arnon","sequence":"additional","affiliation":[{"name":"Department of Neonatology, Meir Medical Center, Kfar-Saba 4428164b, Israel"},{"name":"Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5937-9620","authenticated-orcid":false,"given":"Arieh","family":"Riskin","sequence":"additional","affiliation":[{"name":"Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200003, Israel"},{"name":"Department of Neonatology, Bnai Zion Medical Center, Haifa 32000, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gil","family":"Dinur","sequence":"additional","affiliation":[{"name":"Department of Neonatology, Rambam Health Care Campus, Haifa 3109601, Israel"},{"name":"Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200003, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen","family":"Lavie-Nevo","sequence":"additional","affiliation":[{"name":"Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200003, Israel"},{"name":"Department of Neonatology, Carmel Medical Center, Haifa 3436212, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1897-4754","authenticated-orcid":false,"given":"Ayala","family":"Gover","sequence":"additional","affiliation":[{"name":"Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200003, Israel"},{"name":"Department of Neonatology, Carmel Medical Center, Haifa 3436212, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amir","family":"Kugelman","sequence":"additional","affiliation":[{"name":"Department of Neonatology, Rambam Health Care Campus, Haifa 3109601, Israel"},{"name":"Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200003, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ori","family":"Hochwald","sequence":"additional","affiliation":[{"name":"Department of Neonatology, Rambam Health Care Campus, Haifa 3109601, Israel"},{"name":"Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200003, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,9,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1049","DOI":"10.1038\/s41390-021-01473-y","article-title":"Carbon dioxide levels in neonates: What are safe parameters?","volume":"91","author":"Wong","year":"2022","journal-title":"Pediatr. Res."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e20183640","DOI":"10.1542\/peds.2018-3640","article-title":"Continuous Noninvasive Carbon Dioxide Monitoring in Neonates: From Theory to Standard of Care","volume":"144","author":"Hochwald","year":"2019","journal-title":"Pediatrics"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"648","DOI":"10.1542\/peds.101.4.648","article-title":"Mainstream end-tidal carbon dioxide monitoring in the neonatal intensive care unit","volume":"101","author":"Rozycki","year":"1998","journal-title":"Pediatrics"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e1219","DOI":"10.1542\/peds.2008-1300","article-title":"A novel method of distal end-tidal CO2 capnography in intubated infants: Comparison with arterial CO2 and with proximal mainstream end-tidal CO2","volume":"122","author":"Kugelman","year":"2008","journal-title":"Pediatrics"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1038\/sj.jp.7211202","article-title":"Agreement of carbon dioxide levels measured by arterial, transcutaneous and end tidal methods in preterm infants < or = 28 weeks gestation","volume":"25","author":"Aliwalas","year":"2005","journal-title":"J. Perinatol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1002\/ppul.22593","article-title":"Sidestream microstream end tidal carbon dioxide measurements and blood gas correlations in neonatal intensive care unit","volume":"48","author":"Singh","year":"2013","journal-title":"Pediatr. Pulmonol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1002\/ppul.21558","article-title":"End-tidal carbon dioxide monitoring in very low birth weight infants: Correlation and agreement with arterial carbon dioxide","volume":"47","author":"Trevisanuto","year":"2012","journal-title":"Pediatr. Pulmonol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1016\/j.jpeds.2015.09.051","article-title":"Impact of Continuous Capnography in Ventilated Neonates: A Randomized, Multicenter Study","volume":"168","author":"Kugelman","year":"2016","journal-title":"J. Pediatr."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"S48","DOI":"10.1213\/01.ane.0000278642.16117.f8","article-title":"The design, use, and results of transcutaneous carbon dioxide analysis: Current and future directions","volume":"105","author":"Eberhard","year":"2007","journal-title":"Anesth. Analg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1111\/ped.14107","article-title":"Transcutaneous blood gas monitoring among neonatal intensive care units in Japan","volume":"62","author":"Ochiai","year":"2020","journal-title":"Pediatr. Int."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"R\u00fcdiger, M., T\u00f6pfer, K., Hammer, H., Schmalisch, G., and Wauer, R.R. (2005). A survey of transcutaneous blood gas monitoring among European neonatal intensive care units. BMC Pediatr., 5.","DOI":"10.1186\/1471-2431-5-30"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"556","DOI":"10.1097\/00003246-198906000-00015","article-title":"Discrepancies between transcutaneous and end-tidal carbon dioxide monitoring in the critically ill neonate with respiratory distress syndrome","volume":"17","author":"Hand","year":"1989","journal-title":"Crit. Care Med."},{"key":"ref_13","first-page":"115","article-title":"Combined transcutaneous oxygen, carbon dioxide tensions and end-expired CO2 levels in severely ill newborns","volume":"220","author":"Geven","year":"1987","journal-title":"Adv. Exp. Med. Biol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1016\/S0022-3476(85)80306-1","article-title":"Estimation of PaCO2 by two noninvasive methods in the critically ill newborn infant","volume":"106","author":"Epstein","year":"1985","journal-title":"J. Pediatr."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"F523","DOI":"10.1136\/adc.2004.064717","article-title":"Monitoring of end tidal carbon dioxide and transcutaneous carbon dioxide during neonatal transport","volume":"90","author":"Tingay","year":"2005","journal-title":"Arch. Dis. Child. Fetal Neonatal Ed."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1136\/archdischild-2021-322138","article-title":"Monitoring of carbon dioxide in ventilated neonates: A prospective observational study","volume":"107","author":"Werther","year":"2022","journal-title":"Arch. Dis. Child. Fetal Neonatal Ed."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"F161","DOI":"10.1136\/fetalneonatal-2011-301606","article-title":"End tidal carbon dioxide is as reliable as transcutaneous monitoring in ventilated postsurgical neonates","volume":"98","author":"Tingay","year":"2013","journal-title":"Arch. Dis. Child. Fetal Neonatal Ed."},{"key":"ref_18","first-page":"480","article-title":"Transcutaneous Carbon Dioxide Monitoring with Reduced-Temperature Probes in Very Low Birth Weight Infants","volume":"34","author":"Aly","year":"2017","journal-title":"Am. J. Perinatol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"571","DOI":"10.1080\/10543400701329422","article-title":"Agreement between methods of measurement with multiple observations per individual","volume":"17","author":"Bland","year":"2007","journal-title":"J. Biopharm. Stat."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"90","DOI":"10.4187\/respcare.04212","article-title":"Neonatal Transcutaneous Carbon Dioxide Monitoring\u2014Effect on Clinical Management and Outcomes","volume":"61","author":"Mukhopadhyay","year":"2016","journal-title":"Respir. Care"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"628","DOI":"10.1159\/000510659","article-title":"Validation of a New Transcutaneous tcPO2\/tcPCO2 Sensor with an Optical Oxygen Measurement in Preterm Neonates","volume":"117","author":"Goos","year":"2020","journal-title":"Neonatology"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"840","DOI":"10.1038\/s41390-020-01308-2","article-title":"Transcutaneous carbon dioxide pattern and trend over time in preterm infants","volume":"90","author":"Sullivan","year":"2021","journal-title":"Pediatr. Res."},{"key":"ref_23","first-page":"8041967","article-title":"Accuracy of Transcutaneous Carbon Dioxide Measurement in Premature Infants","volume":"2016","author":"Janaillac","year":"2016","journal-title":"Crit. Care Res. Pract."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1542\/peds.2006-2434","article-title":"Both extremes of arterial carbon dioxide pressure and the magnitude of fluctuations in arterial carbon dioxide pressure are associated with severe intraventricular hemorrhage in preterm infants","volume":"119","author":"Fabres","year":"2007","journal-title":"Pediatrics"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"744","DOI":"10.1097\/00003246-198110000-00015","article-title":"Simultaneous tissue pH and transcutaneous carbon dioxide monitoring in critically ill neonates","volume":"9","author":"Bhat","year":"1981","journal-title":"Crit. Care Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e184","DOI":"10.5812\/ijp.184","article-title":"Agreement of Mixed Venous Carbon Dioxide Tension (PvCO2) and Transcutaneous Carbon Dioxide (PtCO2) Measurements in Ventilated Infants","volume":"25","author":"Uslu","year":"2015","journal-title":"Iran. J. Pediatr."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1159\/000521809","article-title":"Accuracy of a Novel Transcutaneous PCO2 and PO2 Sensor with Optical PO2 Measurement in Neonatal Intensive Care: A Single-Centre Prospective Clinical Trial","volume":"119","author":"Baumann","year":"2022","journal-title":"Neonatology"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1097\/CCM.0b013e31826a427a","article-title":"Indicators of optimal lung volume during high-frequency oscillatory ventilation in infants","volume":"41","author":"Tingay","year":"2013","journal-title":"Crit. Care Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"408","DOI":"10.1203\/00006450-200009000-00025","article-title":"Clinical diagnosis of pneumothorax is late: Use of trend data and decision support might allow preclinical detection","volume":"48","author":"McIntosh","year":"2000","journal-title":"Pediatr. Res."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1002\/ppul.1950120305","article-title":"Estimation of arterial carbon dioxide by end-tidal and transcutaneous PCO2 measurements in ventilated children","volume":"12","author":"Sivan","year":"1992","journal-title":"Pediatr. Pulmonol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/17\/5757\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T20:46:14Z","timestamp":1760129174000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/17\/5757"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,9,4]]},"references-count":30,"journal-issue":{"issue":"17","published-online":{"date-parts":[[2023,9]]}},"alternative-id":["jcm12175757"],"URL":"https:\/\/doi.org\/10.3390\/jcm12175757","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,9,4]]}}}