Transcutaneous carbon dioxide monitoring for the prevention of neonatal morbidity and mortality

Review question. We reviewed the evidence about the effects of different modalities to monitor carbon dioxide (CO2) in the newborn. Does the use of transcutaneous CO2 monitoring improve survival and other important outcomes in newly born infants?

Background. CO2 measurement is a very important procedure because abnormal values of CO2 may have detrimental effects in the sick newborn. There are three main methods to assess CO2: in the arterial blood gas, in the air exhaled from the body, and through the skin, that is, transcutaneously. The latter is minimally invasive and allows continuous monitoring. The evidence is current to November 2015.

Study characteristics and results. No studies were included in this review, and no ongoing studies were identified.

Authors' conclusions: 

There was no evidence to recommend or refute the use of transcutaneous CO2 monitoring in neonates. Well-designed, adequately powered randomized controlled studies are necessary to address efficacy and safety of transcutaneous CO2 monitoring in neonates.

Read the full abstract...

Carbon dioxide (CO2) measurement is a fundamental evaluation in a neonatal intensive care unit (NICU), as both low and high values of CO2 might have detrimental effects on neonatal morbidity and mortality. Though measurement of CO2 in the arterial blood gas is the most accurate way to assess the amount of CO2, it requires blood sampling and it does not provide a continuous monitoring of CO2.


To assess whether the use of continuous transcutaneous CO2 (tcCO2) monitoring in newborn infants reduces mortality and improves short and long term respiratory and neurodevelopmental outcomes.

Search strategy: 

We used the standard search strategy of the Cochrane Neonatal Review group to search the Cochrane Central Register of Controlled Trials (CENTRAL 2015, Issue 11), MEDLINE via PubMed (1966 to November 1, 2015), EMBASE (1980 to November 1, 2015), and CINAHL (1982 to November 1, 2015). We also searched clinical trials databases, conference proceedings, and the reference lists of retrieved articles for randomized controlled trials and quasi-randomized trials.

Selection criteria: 

Randomized, quasi-randomized and cluster randomized controlled trials comparing different strategies regarding tcCO2 monitoring in newborns. Three comparisons were considered, that is, continuous tcCO2 monitoring versus 1) any intermittent modalities to measure CO2; 2) other continuous CO2 monitoring; and 3) with or without intermittent CO2 monitoring.

Data collection and analysis: 

We used the standard methods of the Cochrane Neonatal Review Group. Two review authors independently assessed studies identified by the search strategy for inclusion.

Main results: 

Our search strategy yielded 106 references. Two review authors independently assessed all references for inclusion. We did not find any completed studies for inclusion, nor ongoing trials.