Role of Sodium Bicarbonate to Treat Neonatal Metabolic Acidosis: Beneficial or Not

Abstract

Despite the lack of evidence for effectiveness of sodium bicarbonate in treatment of metabolic acidosis in critically ill patients who are admitted in neonatal and pediatric intensive care unit, bicarbonate administration is a common practice and has a long history of widespread use. The justification for persistent use of this controversial therapy comes from a variety of sources, many of them based in philosophy than in science. Clinicians must consider the intervention which will meet the therapeutic objective & existence of strong scientific evidence. To the contrary, there is increasing evidence of this REVIEW ARTICLE detrimental therapy and adverse effects include diminished oxygen delivery to tissues, worsening intracellular acidosis, aggravated myocardial injury, fluctuations in cerebral blood flow, intracranial hemorrhage and reduces the likelihood success of resuscitation. This review summarizes the evidence and examines the controversy over the use of bicarbonate to treat metabolic acidosis in neonate.

The practices of intravenous sodium bicarbonate therapy in neonatal intensive care units: A multi-country survey

“…[21] Whereas the data of our study showed that even though ISB worsens intracellular acidosis, increases myocardial injury, contributes to intracranial hemorrhage, and decreases oxygen transport to tissues, it is nevertheless often administered as a treatment for MA in new-born intensive care. [10] Our results showed that most participants (80.6%) use normal saline fluid boluses to manage MA rather than the routine administration of ISB. However, according to the Cochrane Database of Systematic Reviews, there is currently insufficient evidence to support the routine intravenous bolus administration of albumin or normal saline to normovolumic neonates suffering MA.…”

“…[5,9] In order to reduce morbidity and mortality and correct MA, SB has been utilized for many years as a treatment for critically ill neonates with metabolic acidemia to reverse MA during newborn resuscitation. [10]…”

“…[21] Whereas the data of our study showed that even though ISB worsens intracellular acidosis, increases myocardial injury, contributes to intracranial hemorrhage, and decreases oxygen transport to tissues, it is nevertheless often administered as a treatment for MA in new-born intensive care. [10]…”

“…[5,9] In order to reduce morbidity and mortality and correct MA, SB has been utilized for many years as a treatment for critically ill neonates with metabolic acidemia to reverse MA during newborn resuscitation. [10] Based on the results of our survey, about 91.2% of neonatologists around the world use sodium bicarbonate to treat MA in the NICU. A study conducted in Germany showed that 4% of the interviewed neonatologists would have administered ISB to correct acidosis.…”