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Abnormal levels of end-tidal carbon dioxide (EtCO 2 ) during resuscitation in the delivery suite are associated with intraventricular haemorrhage (IVH) development. Our aim was to determine whether carbon dioxide (CO 2 ) levels in the first 3 days after birth reflected abnormal EtCO 2 levels in the delivery suite, and hence, a prolonged rather than an early insult resulted in IVH. In addition, we determined if greater EtCO 2 level fluctuations during resuscitation occurred in infants who developed IVH. EtCO 2 levels during delivery suite resuscitation and CO 2 levels on the neonatal unit were evaluated in 58 infants (median gestational age 27.3 weeks). Delta EtCO 2 was the difference between the highest and lowest level of EtCO 2 . Thirteen infants developed a grade 3-4 IVH (severe group). There were no significant differences in CO 2 levels between those who did and did not develop an IVH (or severe IVH) on the NICU. The delta EtCO 2 during resuscitation differed between infants with any IVH (6.2 (5.4-7.5) kPa) or no IVH (3.8 (2.7-4.3) kPA) (p &lt; 0.001) after adjusting for differences in gestational age. Delta EtCO 2 levels gave an area under the ROC curve of 0.940 for prediction of IVH.Conclusion: The results emphasize the importance of monitoring EtCO 2 levels in the delivery suite.What is Known:• Abnormal levels of carbon dioxide (CO 2 ) in the first few days after birth and abnormal end-tidal CO 2 levels (EtCO 2 ) levels during resuscitation are associated in preterm infants with the risk of developing intraventricular haemorrhage (IVH).What is New:• There were no significant differences in NICU CO 2 levels between those who developed an IVH or no IVH.• There was a poor correlation between delivery suite ETCO 2 levels and NICU CO 2 levels.• Large fluctuations in EtCO 2 during resuscitation in the delivery suite were highly predictive of IVH development in preterm infants.

End-tidal carbon dioxide levels during resuscitation and carbon dioxide levels in the immediate neonatal period and intraventricular haemorrhage