School of Medicine, Creighton University, Omaha, NE, USA.
Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA.
J Perinatol. 2024 Aug;44(8):1172-1177. doi: 10.1038/s41372-024-02005-2. Epub 2024 May 20.
To determine the safety and effectiveness of sodium bicarbonate administration in the management of metabolic acidemia and short-term outcomes in neonates with hypoxic-ischemic encephalopathy (HIE).
Retrospective cohort study of neonates born at ≥35 weeks of gestation and receiving therapeutic hypothermia. Demographics, pH, lactate, base deficit, treatment, MRI findings, seizure incidence, death prior to discharge were collected.
There was higher mortality (p = 0.010) and injury on MRI (p = 0.008)-primarily deep gray matter (p < 0.001) and cortical injury (p = 0.003)-in the bicarbonate group compared to controls in univariate analysis. The combined outcome of death or abnormal MRI was not significantly associated (OR 1.97, 95% CI 0.80-4.87, p = 0.141) with bicarbonate administration when adjusting for sex, 5-minute Apgar, and initial base deficit.
This study demonstrated association between bicarbonate use after HIE and negative short-term outcomes. Future prospective trials could overcome the treatment bias limitation demonstrated in this retrospective study.
确定碳酸氢钠在管理患有缺氧缺血性脑病（HIE）的新生儿代谢性酸中毒和短期结局中的安全性和有效性。
对接受治疗性低温治疗的胎龄≥35 周的新生儿进行回顾性队列研究。收集了人口统计学资料、pH 值、乳酸、碱缺失、治疗、MRI 发现、癫痫发作发生率、出院前死亡情况。
与对照组相比，碳酸氢盐组的死亡率（p=0.010）和 MRI 损伤更高（p=0.008）-主要是深部灰质（p<0.001）和皮质损伤（p=0.003）-在单变量分析中。当调整性别、5 分钟 Apgar 评分和初始碱缺失时，碳酸氢盐治疗与死亡或异常 MRI 的联合结局之间没有显著相关性（OR 1.97，95%CI 0.80-4.87，p=0.141）。
本研究表明 HIE 后碳酸氢盐的使用与短期不良结局之间存在关联。未来的前瞻性试验可以克服本回顾性研究中显示的治疗偏差限制。
