Question

• In neonates undergoing cardio-respiratory resuscitation, what is the utility of sodium bicarbonate infusion on immediate outcome?

Clinical Bottom Lines

1. Data from this study show no benefit of using sodium bicarbonate in neonatal resuscitation at birth, with RR of death and neurological impairment being 0.97 (risk difference of 0.02).¹
2. Similar negative results were reported for other outcomes including seizures, cerebral edema, IVH and etc.

Summary of Key Evidence

1. 55 patients requiring PPV after 5min were included in the study. 27 patients were randomly assigned to receive 1.8meq/kg sodium bicarbonate and the other group received D5. Patients with congenital malformations were excluded from the study.¹
2. 18 patients in the sodium bicarbonate group and 19 patients in the D5 group survived.
3. 14 patients in the sodium bicarbonate group compared to 15 patients in the control group suffered either death or neurological impairment (RR 0.97, P=0.88).
4. No significant differences were observed for encephalopathy, cerebral edema, inotropic support, GI bleeds, pulmonary hemorrhage, PPHN or IVH.
5. Arterial pH 6hrs post treatment were equal between groups (7.32).

Additional Comments

• This study did not evaluate long term neurodevelopmental outcomes.
• Whether children with congenital heart disease are more sensitive to acidosis and therefore may benefit more from sodium bicarbonate administration.
• Did not address whether sodium bicarbonate therapy is beneficial in neonates after the initial delivery period during times of acidosis or cardio-respiratory collapse.
• Would have been nice to see classification of acidosis (resp/metabolic) and degree of hypoxia.
• Cannot average logarithmic scale pH values.
  

Citation

1. Lokesh L, Kumar P, Murki S, Narang A. A randomized controlled trial of sodium bicarbonate in neonatal resuscitation - effect on immediate outcome. Resuscitation 2004;60:219-23.
2. Murki M, Kumar P, Lingappa L, Narang A. Effect of a single dose of sodium bicarbonate given during neonatal resuscitation at birth on the acid-base status on first day of life. J Perinatology 2004;24:696-9.

CAT Author: Gabe Owens, MD

CAT Appraisers: Robert Schumacher, MD

Date appraised: March 15, 2006