Katheria A C, Brown M K, Hassan K, Poeltler D M, Patel D A, Brown V K, Sauberan J B
Neonatal Research Institute, Sharp Mary Birch Hospital for Women and Newborns, San Diego, CA, USA.
J Perinatol. 2017 May;37(5):518-520. doi: 10.1038/jp.2016.258. Epub 2017 Feb 16.
To describe the hemodynamic changes that occur with sodium bicarbonate (NaHCO) administration in premature neonates.
This retrospective study included premature neonates 23 to 31+6 weeks of gestational age who underwent continuous cardiac and cerebral monitoring as participants in prospective trials at our institution, and who received NaHCO infused over 30 min in the first 24 h of life. Blood pressure (BP), heart rate, cardiac output (CO), SpO and cerebral oximetry (StO) were captured every 2 s. A baseline was established for all continuous data and averaged over the 10 min before NaHCO administration. Baseline was compared with measurements over 10 min epochs until 80 min after administration. Arterial blood gases before and within 1 h of administration were also compared. Significance was set at P<0.05.
A total of 36 subjects received NaHCO (1.3±0.3 mEq kg) in the first 24 h (14±8.5 h) of life. NaHCO administration increased pH (7.23 vs 7.28, P<0.01) and decreased base deficit (-8.9 vs -6.8, P<0.01) and PaCO (45 vs 43 mm Hg, P<0.05). There was a transient but significant (P<0.05) decrease in systemic BP coinciding with an increase in cerebral oxygenation without an increase in oxygen extraction. CO did not change.
Early postnatal NaHCO administration does not acutely improve CO but does cause transient fluctuations in cerebral and cardiovascular hemodynamics in extremely premature infants.
描述碳酸氢钠（NaHCO）给药后早产儿发生的血流动力学变化。
这项回顾性研究纳入了孕龄23至31⁺⁶周的早产儿，这些早产儿作为我们机构前瞻性试验的参与者接受了连续心脏和大脑监测，并在出生后24小时内30分钟内输注了NaHCO。每2秒记录一次血压（BP）、心率、心输出量（CO）、SpO和脑血氧饱和度（StO）。为所有连续数据建立基线，并在给予NaHCO前10分钟内进行平均。将基线与给药后直至80分钟的10分钟时间段内的测量值进行比较。还比较了给药前和给药后1小时内的动脉血气。显著性设定为P<0.05。
共有36名受试者在出生后24小时（14±8.5小时）内接受了NaHCO（1.3±0.3 mEq/kg）。给予NaHCO后pH值升高（7.23对7.28，P<0.01），碱缺失降低（-8.9对-6.8，P<0.01），PaCO₂降低（45对43 mmHg，P<0.05）。全身血压出现短暂但显著（P<0.05）的下降，同时脑氧合增加，而氧摄取未增加。心输出量未改变。
出生后早期给予NaHCO不会急性改善心输出量，但会导致极早产儿脑和心血管血流动力学出现短暂波动。
