Effect of early clinical management on metabolic acidemia in neonates with hypoxic-ischemic encephalopathy (2024)

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Subjects Abstract Objective Study design Results Conclusion Access options Additional access options: Similar content being viewed by others Positive fluid balance is associated with death and severity of brain injury in neonates with hypoxic–ischemic encephalopathy Characteristics and short-term outcomes of neonates with mild hypoxic-ischemic encephalopathy treated with hypothermia Risk factors for unfavorable outcome at discharge of newborns with hypoxic-ischemic encephalopathy in the era of hypothermia Data availability References Author information Authors and Affiliations Contributions Corresponding author Ethics declarations Competing interests Ethics approval and consent to participate Additional information Supplementary information Supplementary information Rights and permissions About this article Cite this article References
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Subjects

  • Adverse effects
  • Brain injuries
  • Paediatrics

Abstract

Objective

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).

Study design

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.

Results

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 groupcompared 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.

Conclusion

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.

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Similar content being viewed by others

Effect of early clinical management on metabolic acidemia in neonates with hypoxic-ischemic encephalopathy (3)

Positive fluid balance is associated with death and severity of brain injury in neonates with hypoxic–ischemic encephalopathy

Article 01 March 2021

Effect of early clinical management on metabolic acidemia in neonates with hypoxic-ischemic encephalopathy (4)

Characteristics and short-term outcomes of neonates with mild hypoxic-ischemic encephalopathy treated with hypothermia

Article 13 November 2019

Effect of early clinical management on metabolic acidemia in neonates with hypoxic-ischemic encephalopathy (5)

Risk factors for unfavorable outcome at discharge of newborns with hypoxic-ischemic encephalopathy in the era of hypothermia

Article 22 October 2022

Data availability

The de-identified dataset generated and analyzed in the current study is available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. School of Medicine, Creighton University, Omaha, NE, USA

    Erastus Thuo

  2. Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA

    Elizabeth R. Lyden

  3. Department of Pediatrics, University of Nebraska Medical Center, Omaha, NE, USA

    Eric S. Peeples

  4. Child Health Research Institute, Omaha, NE, USA

    Eric S. Peeples

  5. Children’s Nebraska, Omaha, NE, USA

    Eric S. Peeples

Authors

  1. Erastus Thuo

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  2. Elizabeth R. Lyden

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  3. Eric S. Peeples

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Contributions

ESP and ET contributed to study design, interpretation of the data, drafted the initial manuscript, and reviewed and critically revised the manuscript. ERL performed the analysis, contributed to interpretation of the data, and reviewed and critically revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Eric S. Peeples.

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The authors declare no competing interests.

Ethics approval and consent to participate

This study was approved by the University of Nebraska Medical Center Institutional Review Board (0205-22-EX) with waiver of consent.

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Effect of early clinical management on metabolic acidemia in neonates with hypoxic-ischemic encephalopathy (6)

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Thuo, E., Lyden, E.R. & Peeples, E.S. Effect of early clinical management on metabolic acidemia in neonates with hypoxic-ischemic encephalopathy. J Perinatol (2024). https://doi.org/10.1038/s41372-024-02005-2

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Effect of early clinical management on metabolic acidemia in neonates with hypoxic-ischemic encephalopathy (2024)

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