Abstract

Background: Late neonatal metabolic acidosis except for metabolic asidosis secondary to perinatal asphyxia generally caused by severe diseases and results in irreversible adverse outcomes.

Method: The findings of hospitalized neonates without perinatal asphyxia and with gestational age>35 weeks and clinical findings of shock were analysed retrospectively. At admission, the neonates with pH≤7.30, HCO3≤16 mmol/L, base excess≥8 mmol/L, and requirement of NaHCO3 infusion were included in the study. The etiology for metabolic asidosis, factors affecting prognosis, and the effect of NaHCO3 infusion on blood gases were investigated in this study.

Results: Among 1284 newborns hospitalized in our hospital between October, 2009 and September, 2010; 32 neonates with significant metabolic acidosis and clinical findings of shock required NaHCO3 infusion. Hypovolemic, septic, and cardiogenic shock were determined in 21.9%, 28.1%, and 50% of neonates; retrospectively. The stages of shock were defined as compensated, decompensated, and irreversible shock in 21.9%, 37.5%, 40.6% of neonates; respectively. There were also accompanied disseminated intravascular coagulation (43.8%), multiple organ failure (28.1%), liver failure (20.5%), and acute renal failure (21.9%) in neonates with metabolic asidosis. The most common etiological disorders for development of late metabolic asidosis were congenital heart diseases [transposition of great arteries, pulmonary atresia, coarctation, aortic interruption, cardiomyopathy, atrio-ventricular canal defect (31.3%)], sepsis (28.1%), acute renal failure (18.8%), inborn errors of metabolism [propionic acidemia, methyl-malonic acidemia, citrullinemia, galactosemia, leprechaunism (18.8%)].After the infusion of NaHCO3; a statistically significant improvement was detected on parameters of pH, HCO3, and base excess (p<0.05). The mortality rate was 28.1% in this series. The relationship between mortality and requirement of mechanical ventilation; the diagnosis of congenital heart disease, septicemia, congenital anomalies; serum levels of pH, pO2, pCO2, K+, Ca++, uric acid, PT, INR, anion gap, NTISS was found to be statistically significant (p<0.05). Nine neonates who was lost had higher NTISS scores than the neonates who were not lost (p= 0.017).

Conclusion: Late neonatal metabolic acidosis is often associated with severe diseases, and may have high mortality rates. NaHCO3 infusion together with other supportive therapies may contribute to the improvement of the asidosis

Keywords: Metabolik asidoz, yenidoğan, sodyum bikarbonat

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1.
Ünal S, Bilgin L, Öncel MY, Gündüz M, Ekici F, Çetin İİ. ETIOLOGY OF METABOLIC ACIDOSIS IN PREVIOUSLY HEALTHY NEONATES AND ITS PROGNOSIS. Turk J Pediatr Dis [Internet]. 2011 Jun. 1 [cited 2025 May 24];5(3):162-8. Available from: https://turkjpediatrdis.org/article/view/151