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Decreased cerebral blood flow after administration of sodium bicarbonate in the distressed newborn infant
Insights
Sodium bicarbonate infusion significantly reduced cerebral blood flow in distressed newborn infants, potentially worsening cerebral ischemia. This finding impacts treatment strategies for acidotic newborns.
Area of Science:
- Neonatal physiology
- Neurology
- Pediatric critical care
Background:
- Neonatal acidosis is a common complication requiring treatment.
- Sodium bicarbonate is frequently used to correct acidosis in newborns.
- Cerebral blood flow (CBF) regulation is critical in neonates.
Observation:
- A significant decrease in cerebral blood flow was observed following sodium bicarbonate administration.
- CBF reductions were noted in six out of seven distressed newborn infants studied.
- The 133Xe clearance technique was employed to measure CBF.
Findings:
- Sodium bicarbonate infusion markedly reduced CBF, with values often halved.
- In one case, CBF dropped to critically low levels (3 ml/100 g/min).
- These reductions suggest a potential for aggravating existing cerebral ischemia.
Implications:
- The findings raise concerns about the safety of sodium bicarbonate in acidotic newborns with compromised cerebral perfusion.
- Clinical guidelines for managing neonatal acidosis may need re-evaluation.
- Further research is warranted to explore alternative or modified bicarbonate therapies.
Abstract:
In the course of our studies on cerebral blood flow in newborn infants, we have observed a striking depressing effect of sodium bicarbonate infusion on cerebral blood flow which in some cases may severely aggravate cerebral ischemia. We measured cerebral blood flow before and after the treatment with 1 to 8 meqs of sodium bicarbonate in seven distressed newborn infants. The 133 Xe clearance technique was used. The results showed in six of the seven cases a decrease in cerebral blood flow, which in most cases was reduced to 14 to 22 ml/100 g/min, which is about half the value prior to the bicarbonate infusion. In one case an extreme reduction occurred: cerebral blood flow was reduced to 3 ml/100 g/min, well below the level compatible with tissue survival. The results are discussed with regard to the optimal treatment of the acidotic newborn.