Early versus late treatment of neonatal acidosis in low-birth-weight infants: Relation to respiratory distress syndrome

Abstract

Neonatal acidosis was detected by analysis of fetal scalp, umbilical cord arterial, or umbilical arterial blood during the immediate perinatal period in 90 preterm low-birth-weight (appropriate-for-date) infants. The acidosis was randomly treated early (at approximately 30 minutes of life) or late (approximately 2 1/2 hours) by rapid intravascular infusion of sodium bicarbonate. Serial analyses revealed that the group treated early had a higher arterial blood pH during the first 24 hours and a higher Pao2 during the first three hours of life. The incidence of respiratory distress syndrome was similar in the early and late treatment groups; however the severity of the disease was significantly milder in the early treatment group. There was no significant difference in the mortality rates between the early and late treatment groups, whether the infants weighed less than 1,500 Gm. or between 1,501 and 2,250 Gm. However, when infants who weighed 1,001 to 1,500 Gm. were considered separately by retrospective analysis, more of those treated late died (9 of 21) than those treated early (4 of 21). It was concluded that early detection and correction of neonatal acidosis in low-birth-weight infants is helpful in reducing the morbidity rate and may improve the survival rate of infants with respiratory distress syndrome. Neonatal acidosis was detected by analysis of fetal scalp, umbilical cord arterial, or umbilical arterial blood during the immediate perinatal period in 90 preterm low-birth-weight (appropriate-for-date) infants. The acidosis was randomly treated early (at approximately 30 minutes of life) or late (approximately 2 1/2 hours) by rapid intravascular infusion of sodium bicarbonate. Serial analyses revealed that the group treated early had a higher arterial blood pH during the first 24 hours and a higher Pao2 during the first three hours of life. The incidence of respiratory distress syndrome was similar in the early and late treatment groups; however the severity of the disease was significantly milder in the early treatment group. There was no significant difference in the mortality rates between the early and late treatment groups, whether the infants weighed less than 1,500 Gm. or between 1,501 and 2,250 Gm. However, when infants who weighed 1,001 to 1,500 Gm. were considered separately by retrospective analysis, more of those treated late died (9 of 21) than those treated early (4 of 21). It was concluded that early detection and correction of neonatal acidosis in low-birth-weight infants is helpful in reducing the morbidity rate and may improve the survival rate of infants with respiratory distress syndrome.