Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Stony Brook Children's Hospital, Stony Brook, NY, USA.
Department of Pediatrics, Division of Newborn Medicine, The Regional Neonatal Intensive Care Unit, Maria Fareri Children's Hospital at Westchester Medical Center, Valhalla, NY, USA.
J Perinatol. 2015 Aug;35(8):601-6. doi: 10.1038/jp.2015.37. Epub 2015 Apr 30.
To determine the effects of sodium bicarbonate (NaHCO3) correction of metabolic acidosis on cardiopulmonary, laboratory, and cerebral, renal and splanchnic regional oxygen saturation (rSO2) and fractional tissue oxygen extraction (FTOE) in extremely premature neonates during the first postnatal week.
Observational cohort data were collected from 500 to 1250 g neonates who received NaHCO3 'half' corrections (0.3 * Weight (kg) * Base Deficit (mmol l(-1))) for presumed renal losses.
Twelve subjects with normal blood pressure and heart rate received 17 NaHCO3 corrections. Mean (±s.d.) gestational age was 27±2 week and birth weight was 912±157 g. NaHCO3 corrections provided a mean (±s.d.) 4.5±1.0 ml kg(-1) fluid bolus, shifted mean (±s.d.) base deficit from 7.6±1.8 to 3.4±2.1 mmol l(-1) (P<0.05), and increased median (±s.d.) pH from 7.23±0.06 to 7.31±0.05 (P<0.05). No significant changes in blood pressure, pulse oximetry, PCO2, lactate, sodium, blood urea nitrogen, creatinine or hematocrit were observed. Cerebral, renal and splanchnic rSO2 (74%, 66% and 44%, respectively, at baseline) and FTOE (0.21, 0.29 and 0.52, respectively, at baseline) were unchanged following NaHCO3 correction.
NaHCO3 infusions decreased base deficits and increased pH though produced no discernible effects or benefits on cardiopulmonary parameters including rSO2 and FTOE. These findings warrant further prospective evaluation in larger populations with more significant metabolic acidosis to determine the utility of tissue oxygenation monitoring in differentiating metabolic acidosis due to oxygen delivery/consumption imbalance versus renal bicarbonate losses.
确定在出生后第一周内，碳酸氢钠（NaHCO3）纠正代谢性酸中毒对极低出生体重儿心肺、实验室和脑、肾和内脏区域氧饱和度（rSO2）和组织氧摄取分数（FTOE）的影响。
从 500 至 1250 克接受 NaHCO3“半量”纠正（0.3*体重（kg）*基础缺失（mmol l(-1)))的早产儿中收集观察性队列数据，用于推测肾丢失。
12 名血压和心率正常的受试者接受了 17 次 NaHCO3 纠正。平均（±s.d.）胎龄为 27±2 周，出生体重为 912±157 g。NaHCO3 纠正提供了平均（±s.d.）4.5±1.0 ml kg(-1)的液体冲击，平均（±s.d.）基础缺失从 7.6±1.8 变为 3.4±2.1 mmol l(-1)（P<0.05），并使中位数（±s.d.）pH 值从 7.23±0.06 变为 7.31±0.05（P<0.05）。未观察到血压、脉搏血氧饱和度、PCO2、乳酸、钠、尿素氮、肌酐或血细胞比容的显著变化。NaHCO3 纠正后，脑、肾和内脏 rSO2（分别为 74%、66%和 44%，基线时）和 FTOE（分别为 0.21、0.29 和 0.52，基线时）没有变化。
尽管碳酸氢钠输注降低了基础缺失并增加了 pH 值，但对心肺参数（包括 rSO2 和 FTOE）没有明显的影响或益处。这些发现需要在更大的代谢性酸中毒人群中进行进一步的前瞻性评估，以确定组织氧合监测在区分由于氧输送/消耗失衡与肾碳酸氢盐丢失引起的代谢性酸中毒方面的效用。
