Repeated blood sampling in neonates can lead to iatrogenic anaemia and the requirement for multiple blood transfusions, which are not without risks. Follow up of extremely preterm infants exposed to multiple heel prick tests in the neonatal period has shown that this can result in hyperalgesia and increased sensitivity to painful stimuli. MRI studies have found that early exposure to pain stress in preterm infants is associated with reduced white matter and subcortical brain matter maturation. Frequent blood sampling can also be painful for infants when there is no indwelling arterial catheter. Indwelling catheters in neonates can be associated with an increased risk of infection and thrombosis.
This is the most accurate measurement of CO 2 levels, however, it is not without complications. The current gold standard for monitoring CO 2 levels in newborn infants is by arterial blood gas analysis.
The recent European Consensus Guidelines recommend that clinicians should avoid abnormal levels of CO 2 by regular or continuous assessment of CO 2 levels. Furthermore, outcomes of term-born neonates exposed to high CO 2 variability during therapeutic hypothermia have been associated with adverse neurodevelopment at follow up.
Disturbances in cerebral blood flow caused by the magnitude of difference in CO 2 levels and abnormalities in CO 2 levels can lead to intraventricular haemorrhage (IVH) and periventricular leukomalacia (PVL) and subsequent cerebral injury. Mechanical ventilation can be lifesaving for neonates, but long-term complications are increased in infants who have suffered abnormalities in carbon dioxide (CO 2) levels.
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