In a small baby unit, transcutaneous CO2 monitoring can support care teams in delivering the high level of care preterm babies require. The technology provides continuous CO2 monitoring, supporting timely assessments of respiratory status to aid in protecting the vulnerable brains and lungs of neonatal patients. Offering this monitoring noninvasively also helps minimize pain and blood loss, and supports care teams in protecting the fragile skin of their patients. Here, we’ll explore these key benefits and how they can make a lasting impact on patients in a small baby unit.

Premature infants often require complex care that must carefully balance numerous needs and priorities. Here are five ways transcutaneous CO2 monitoring can support care teams navigating this level of care in a small baby unit:

Patients in a SBU frequently require some level of ventilatory support. However, the fragile, underdeveloped lungs of premature infants are particularly susceptible to negative outcomes from ventilation: failing to deliver enough volume can result in derecruitment and atelectasis, while delivering too much risks overdistension and volutrauma. This can often become a balancing act of competing priorities: brain and lung protection often remain in constant tension during a premature infant’s NICU stay. The more underdeveloped the patient’s organs, the more risk involved and the more difficult this balancing act becomes.

As SBUs manage ventilatory support strategies for their patients, continuous visibility to CO2 can be a powerful, even vital, tool. This continuous insight can enable care teams to identify each infant’s safe window of support by targeting effective gas exchange, guiding necessary adjustments in pursuit of the gentlest ventilatory settings that adequately support the patient. Transcutaneous monitoring offers SBUs this continuous visibility, helping care teams work to safeguard their patients from potential lung damage.

One study found that 30% of neonates’ circulating blood volume was drawn for lab work each week in their first six weeks of life. ¹⁰ While frequent laboratory testing allows clinicians to closely monitor key parameters, like PCO2, it can end up being a significant source of blood loss for infants in the NICU. These procedures can be particularly concerning for premature patients in the SBU, who don’t have much blood to give in the first place. Minimizing blood loss during care can help this and other complications associated with blood loss, such as the need for transfusions.

Transcutaneous monitoring enables noninvasive measurement of patients’ CO2 levels, lessening the need for frequent blood draws without sacrificing visibility to this important parameter. ⁹  Although blood draws provide crucial information and remain a necessary tool in the NICU, efforts to reduce unnecessary blood loss where possible can make a significant impact for these delicate patients. Transcutaneous monitoring can be an impactful tool in these efforts.

In a small baby unit, safeguarding the skin is a top priority. Because of its delicate, underdeveloped nature, the skin of premature infants is susceptible to damage from skin-breaking procedures like blood draws. Repeated interventions such as heel sticks can result in complications like cellulitis, perichondritis, calcaneal osteomyelitis, and abscesses. ¹¹ By providing continuous, real-time CO2 readings, transcutaneous monitoring reduces reliance on blood draws, promoting less invasive care for these delicate patients.

Twenty years ago, early transcutaneous monitors, which required sensors to operate at temperatures up to 44°C, often caused skin issues and needed frequent repositioning. Today’s advanced systems operate at a lower temperature of 41°C, allowing sensors to stay in place for up to 8 hours and reducing the need for frequent adjustments. In addition, some attachment options designed specifically for small babies allow the sensor to be secured without adhesive, supporting visibility in those crucial first days, even in high humidity.

Sentec transcutaneous monitoring offers a range of skin-friendly attachment solutions designed for the delicate skin of neonatal patients.

All-purpose attachment ring for mature, intact skin featuring acrylic-based adhesive

All-purpose attachment ring featuring silicone based adhesive for fragile skin

For gentle attachment in VLBW infants, especially in high-humidity environments

Single-use contact gel that enables convenient workflow & supports infection control

References 

1. 1. Hochwald, O., et al. Continuous Noninvasive Carbon Dioxide Monitoring in Neonates: From Theory to Standard of Care. Pediatrics. 2019.
   2. Travers C.P., et al. A Quality Improvement Bundle to Improve Outcomes in Extremely Preterm Infants in the First Week. Pediatrics. 2022.
   3. Rupawala, M., et al. A Developmental Shift in Habituation to Pain in Human Neonates. Current Biology. 2023.
   4. Grunau, R.E., et al. Neonatal Pain, Parenting Stress and Interaction, In Relation To Cognitive And Motor Development At 8 And 18 Months In Preterm Infants. Pain. 2009.
   5. Chau, S.M.Y, et al. Hippocampus, Amygdala, and Thalamus Volumes in Very Preterm Children at 8 Years: Neonatal Pain and Genetic Variation. Front Behav Neorosci. 2019.
   6. Hall, R.W., et al. Pain Management in Newborns. Clin Perinatol. 2014.
   7.  Kapellou, O. Blood Sampling Infants (Reducing Pain and Morbidity). BMJ Clin Evid. 2009.
   8.  Alves-Dunkerson, J.A., et al. Cost analysis of a neonatal point-of-care monitor. Am J Clin Pathol. 2002.
   9. Mukhopadhyay, S, et al. Neonatal Transcutaneous Carbon Dioxide Monitoring—Effect on Clinical Management and Outcomes. Respir Care. 2016.
   10. Carroll, P.D., Widness, J.A. Nonpharmacological, blood conservation techniques for preventing neonatal anemia–effective and promising strategies for reducing transfusion. Semin Perinatol. 2012.
   11. Lilien, L.D., et al. Neonatal osteomyelitis of the calcaneus: complication of heel puncture. J Paediatr. 1976.