Metabolic acidosis in the first 14 days of life in infants of gestation less than 26 weeks

Bourchier, D; Weston, Philip J.

doi:10.1007/s00431-014-2364-9

Cited by 21 publications

(10 citation statements)

References 26 publications

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“…It is well established that preterm infants are more likely to develop hyperbilirubinemia due to an immature gastrointestinal tract and hepatic conjugating system . Preterm infants are also more susceptible to bilirubin toxicity because of an immature blood brain barrier and clinical instability . Phototherapy is an effective treatment for hyperbilirubinemia, and guidelines for phototherapy in preterm infants are based on total serum bilirubin (TSB) levels .…”

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confidence: 99%

Newborn Metabolic Profile Associated with Hyperbilirubinemia With and Without Kernicterus

McCarthy

Oltman

Baer

et al. 2018

Clinical Translational Sci

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Our objective was to assess the relationship between hyperbilirubinemia with and without kernicterus and metabolic profile at newborn screening. Included were 1,693,658 infants divided into a training or testing subset in a ratio of 3:1. Forty‐two metabolites were analyzed using logistic regression (odds ratios (ORs), area under the receiver operating characteristic curve (AUC), 95% confidence intervals (CIs)). Several metabolite patterns remained consistent across gestational age groups for hyperbilirubinemia without kernicterus. Thyroid stimulating hormone (TSH) and C‐18:2 were decreased, whereas tyrosine and C‐3 were increased in infants across groupings. Increased C‐3 was also observed for kernicterus (OR: 3.17; 95% CI: 1.18–8.53). Thirty‐one metabolites were associated with hyperbilirubinemia without kernicterus in the training set. Phenylalanine (OR: 1.91; 95% CI: 1.85–1.97), ornithine (OR: 0.76; 95% 0.74–0.77), and isoleucine + leucine (OR: 0.63; 95% CI: 0.61–0.65) were the most strongly associated. This study showed that newborn metabolic function is associated with hyperbilirubinemia with and without kernicterus.

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confidence: 99%

Newborn Metabolic Profile Associated with Hyperbilirubinemia With and Without Kernicterus

McCarthy

Oltman

Baer

et al. 2018

Clinical Translational Sci

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“…Extremely preterm infants (born at <28 weeks of postmenstrual age) are most vulnerable to intraventricular hemorrhage and respiratory and metabolic acidosis requiring frequent ventilatory adjustments and fluid and electrolyte imbalance in the first postnatal week and therefore need frequent blood tests to monitor their cardiorespiratory status to optimize intensive care. As a result of repeated phlebotomy losses these infants receive frequent transfusions during the first week of life .…”

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confidence: 99%

Effect of blood transfusion on intestinal blood flow and oxygenation in extremely preterm infants during first week of life

2015

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“…Such variability could also be explained by means of different criteria used to de ne neonatal MA in studies thereof [17][18][19]. Moreover, normal arterial lactate values are in uenced by the hours of life of the infant, with described thresholds ranging from more than 3.8 mmol/l (at 48 hrs.)…”

Section: Discussionmentioning

confidence: 99%

“…Intravenous SB solutions are highly hypertonic. The 1:1 dilution is the most used by the surveyed centers and frequently recommended [17][18][19][20][21][22], yet still being hypertonic.…”

Section: Discussionmentioning

confidence: 99%

Use of Intravenous Sodium Bicarbonate in Neonatal Intensive Care Units in Italy: A Nationwide Survey

Massenzi

Aufieri

Donno³

et al. 2020

Preprint

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Background Metabolic Acidosis (MA) is a disturbance of the acid-base balance that can occur in preterm and critically ill term neonates due to different etiologies. Intravenous sodium bicarbonate (SB) has been traditionally used to correct such unbalance, despite the lack of evidence about its safety and efficacy. In literature, reported undesirable effects of treatment with SB in neonates include worsening of intracellular acidosis, impairment of myocardial function, cerebral blood flow fluctuations and intracranial hemorrhage. A national survey was conducted by the Neonatal Pharmacotherapy Study Group of the Italian Society of Neonatology with the aim to assess and describe attitudes and practices concerning the use of SB, particularly for the treatment of MA in Italian NICUs. Methods A questionnaire regarding treatment of MA and SB prescription habits was sent to the directors of 120 Italian NICUs from June 2017 to March 2018. Results The survey response rate was 97.5% (117/120 centers). Findings showed that in 55% of the surveyed NICUs (64/117 units) it is common practice to correct MA with intravenous SB. On the other hand, the remaining 45% of the units try to solve the metabolic disturbances adopting different approaches (improving perfusion, adjusting ventilation parameters or increasing blood volume). Moreover, to prevent the occurrence of MA, 37.6% of the NICUs (44/117) include buffer salts (lactate, acetate or both) in parenteral nutrition prescriptions. SB is also used as a treatment for other conditions, mainly pathologies with bicarbonate loss and tubular acidosis (respectively in 53.8% and 32.5% of the NICUs). Conclusion This survey showed how SB is a commonly used treatment for MA in more than half of Italian NICUs, with indications and prescription criteria that significantly vary across centers. Based on current knowledge, it is reasonable to suggest that the management of neonatal MA should be firstly directed to identify the underlying disorders. Thus, the use of SB should be reserved only for selected cases, also considering the severity of SB adverse effects and the lack of evidence about its efficacy. Guidance for the management of MA is required to harmonize practices and reduce the use of potentially inappropriate and unsafe treatments.

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Metabolic acidosis in the first 14 days of life in infants of gestation less than 26 weeks

Abstract: Extremely preterm infants experience a self-limiting normal anion gap metabolic acidosis in the first 2 weeks of life which is consistent with renal tubular immaturity.

Cited by 21 publications

References 26 publications

Newborn Metabolic Profile Associated with Hyperbilirubinemia With and Without Kernicterus

Newborn Metabolic Profile Associated with Hyperbilirubinemia With and Without Kernicterus

Effect of blood transfusion on intestinal blood flow and oxygenation in extremely preterm infants during first week of life

Use of Intravenous Sodium Bicarbonate in Neonatal Intensive Care Units in Italy: A Nationwide Survey

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