A Survey of Intravenous Sodium Bicarbonate in Neonatal Asphyxia among European Neonatologists: Gaps between Scientific Evidence and Clinical Practice

Abstract

Background: Birth asphyxia is characterized by intermittent periods of hypoxia/ischemia leading to metabolic acidosis. The use of intravenous sodium bicarbonate (IVSB) is still a matter of controversy in clinical practice. Objective: To assess the use of IVSB in birth asphyxia by attending neonatologists in European hospitals. Design/Methods: Survey using a questionnaire administered to neonatologists in Europe whose electronic addresses were provided by the national councils of neonatology of each participating country. The questionnaire consisted of a brief theoretical introduction followed by demographic questions related to the respondent’s professional qualification. This was followed by a clinical case of an asphyxiated term neonate with severe combined metabolic and respiratory acidosis and case-specific questions related to the perceived indication for administration of IVSB and use of additional therapies to address the clinical situation. Descriptive statistics and χ² analysis were performed. Results: The questionnaire was answered by 259 neonatologists from 17 countries. IVSB was believed to be indicated by 109 (42.2%) of the respondents in this clinical scenario. Results differed significantly between countries, with IVSB use varying from as high as 68% in Portugal and <5% in Scandinavian countries. However, there were no differences in the choice of other therapeutic measures. Conclusions: Although scientific evidence suggests that IVSB is not effective in asphyxiated newborns and current guidelines do not recommend its use, 42.2% of the consulted neonatologists in Europe would use it, with significant differences between but not within countries. There were no differences regarding additional measures to overcome asphyxia. Strategies to implement use of internationally accepted guidelines are needed.

Infusing Sodium Bicarbonate Suppresses Hydrogen Peroxide Accumulation and Superoxide Dismutase Activity in Hypoxic-Reoxygenated Newborn Piglets

“…Indeed, it may be dangerous to use SB during hypoxia-ischemia of neonates because of paradoxical acidosis [2], [6], [7]. Interestingly, in a recent questionnaire survey, over 40% of consultant neonatologists in Europe would prescribe SB to asphyxiated neonates with severe metabolic acidosis [8]. Therefore, the effectiveness of SB in the overall recovery of this particular group of infants needs to be further examined.…”

Just Say No to iNO in Preterms—Really?

“…Physician Decision-Making at the Bedside Several studies 60,61 suggest that neonatologists do not consistently follow evidence-based clinical practice recommendations, which may be due to multiple factors. 26 A recent mixed-methods study of neonatologists to explore factors that influence bedside decision-making concerning the use of iNO in infants born extremely preterm in HRF was assessed by a vignette-based survey among neonatal members of the American Academy of Pediatrics (AAP).…”

What is new in the European and UK neonatal resuscitation guidance?

“…Human evidence for the effectiveness of any drug during newborn resuscitation is extremely limited due to the rarity of this situation. There is a reluctance to totally abandon this drug 44. This is because there is some evidence that reversal of intracardiac acidosis using alkali may sometimes restore the heart rate when all else has failed45 and because many of the concerns about potential harm from bicarbonate relate to its use to correct acidosis after restoration of the circulation and not during resuscitation.…”