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Hyaline-membrane disease, alkaline buffer treatment, and cerebral intraventricular halphaemorrhage
Insights
Sodium bicarbonate treatment in preterm infants with hyaline-membrane disease (HMD) did not increase the incidence of intraventricular hemorrhage (IVH). This study suggests sodium bicarbonate therapy is not a major cause of IVH.
Area of Science:
- Neonatal Medicine
- Pediatric Pathology
- Clinical Pharmacology
Background:
- Hyaline-membrane disease (HMD) is a significant cause of mortality in preterm infants.
- Cerebral intraventricular hemorrhage (IVH) is a common complication in preterm infants, often associated with HMD.
- The role of sodium bicarbonate therapy in the pathogenesis of IVH has been a subject of investigation.
Purpose of the Study:
- To investigate the association between sodium bicarbonate administration and the incidence of intraventricular hemorrhage (IVH) in preterm infants with hyaline-membrane disease (HMD).
- To determine if increased sodium bicarbonate dosage correlates with IVH development.
- To compare the incidence of IVH in preterm infants before and after the widespread use of alkaline buffer treatment.
Main Methods:
- Retrospective analysis of 55 preterm infants who died from HMD between 1971-74.
- Comparison of sodium bicarbonate administration in infants with HMD versus those with HMD and associated IVH (HMD/IVH).
- Correlation analysis between maximum serum-sodium concentrations, sodium bicarbonate dosage, and IVH incidence.
- Historical comparison of IVH incidence rates between 1971-74 and 1956-59.
Main Results:
- Infants with HMD/IVH received more intravascular sodium bicarbonate solution compared to infants with HMD alone.
- A significant proportion of sodium bicarbonate in HMD/IVH infants was administered in response to clinical signs of IVH.
- Maximum serum-sodium concentrations correlated with sodium bicarbonate dosage, but not directly with IVH.
- The incidence of IVH in preterm infants remained unchanged between 1971-74 and 1956-59, a period before alkaline buffer treatment was common.
Conclusions:
- Sodium bicarbonate therapy does not appear to play a major role in the pathogenesis of intraventricular hemorrhage (IVH) in preterm infants.
- While higher sodium bicarbonate doses correlate with higher serum sodium levels, this does not directly translate to increased IVH incidence.
- The findings suggest that current therapeutic practices involving sodium bicarbonate are unlikely to be a primary driver of IVH in this vulnerable population.
Abstract:
In 55 preterm infants dying from hyaline-membrane disease (H.M.D.) in 1971-74, infants with associated cerebral intraventricular haemorrhage (H.M.D./I.V.H.) had been given more intravascular sodium-bicarbonate solution, but the same proportions of cases with H.M.D. and H.M.D./I.V.H. received bicarbonate at the time of birth. Much of the sodium-bicarbonate solution given to H.M.D./I.V.H. infants was injected in response to the clinical effects of I.V.H. Maximum serum-sodium concentrations correlated with sodium-bicarbonate dosage but not I.V.H. The incidence of I.V.H. in preterm infants in 1971-74 was unchanged from 1956-59 when alkaline buffer treatment was not used. These findings do not suggest that sodium-bicarbonate therapy plays a major part in the pathogenesis of I.V.H.