Na Bicarbonate for neonates

[hehady]

When would you consider giving Na Bicarbonate for your neonates?
What is the dosage? and how fast would you give it?

[manuel perez valdez]

the use of na bicarbnate is very precise, and i think this papers are usefull to find the correct answer:
1) Effects of Rapid versus Slow Infusion of Sodium
Bicarbonate on Cerebral Hemodynamics and
Oxygenation in Preterm Infants
Biol Neonate 2006;90:122–127.
2) Severe Umbilical Cord Acidemia and
Neurological Outcome in
Preterm and Full-Term Neonates
Biol Neonate 2005;88:27–34.

[Alexander Rakow]

When would you consider giving Na Bicarbonate for your neonates?
What is the dosage? and how fast would you give it?

Do you refer to
1) the use of buffert at resuscitation or
2) treatment of prolonged but slight metabolic acidosis sometimes seen in (well) preterm infants?

[hehady]

Dear Alexander

I meant both conditions

[mbenelisha]

Dear hehady
Addressing Bicarbonate therapy:
- During resuscitation, I suggest to follow the NRP guidelines ie. 4 cc/kd of BiC 4.2% during 10-15 mn.
- The treatment of prolonged mild acidosis is more controversial. Sometimes is may due to dehydration and the treatment must be correction of dehydration instead of giving BiC with all its side effects. When the acidosis is pure metabolic and not in emergency I found that there are controversies and no concensus about the right way to treat it.
I hope that I helped a little in solving part of the dilemma.
Moti Ben Elisha
Neonatologist
Nahariya hospital for Western Galilee
Israel

[kpsanghvi]

We almost always never use bicarb in neonatal resuscitaion or during normal care unless we document metab acidosis which does not correct even after fluid therapy and if the pH < 7.2 or ABE is > -10.

[Audrius]

Dear collegue,
just my vision to your question:

1.During resuscitation in delivery room bicarb allows to save the live but not the brain, unfortunately.
2.In NICU first step would be most appropriate to try to find main cause of acidosis, after to try solve it and after - bicarb ... maybe.
3.In our practise we have very few indications for use bicarb - late shock with no responce to fluids and inotropes and some cong metabolic diseases(rare).

Re AAP recomendations: if you follow them, they are in permanent process of changes( ventilation/chest compressions ratio, oxygen, prevention of MAS, etc.). I believe that bicarb will be removed from the list of delivery room drugs in the future.

Audrius_LT