Intervention Review

Rapid correction of early metabolic acidaemia in comparison with placebo, no intervention or slow correction in LBW infants

  1. Zsuzsoka Kecskes1,*,
  2. Mark W Davies2

Editorial Group: Cochrane Neonatal Group

Published Online: 21 JAN 2002

Assessed as up-to-date: 11 MAR 2004

DOI: 10.1002/14651858.CD002976


How to Cite

Kecskes Z, Davies MW. Rapid correction of early metabolic acidaemia in comparison with placebo, no intervention or slow correction in LBW infants. Cochrane Database of Systematic Reviews 2002, Issue 1. Art. No.: CD002976. DOI: 10.1002/14651858.CD002976.

Author Information

  1. 1

    The Canberra Hospital, Centre for Newborn Care, Canberra, ACT, Australia

  2. 2

    Royal Brisbane and Women's Hospital, Grantley Stable Neonatal Unit, Brisbane, Queensland, Australia

*Zsuzsoka Kecskes, Centre for Newborn Care, The Canberra Hospital, Woden, Canberra, ACT, 2506, Australia. zsuzsoka.kecskes@act.gov.au.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 21 JAN 2002

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Metabolic or mixed (metabolic and respiratory) acidosis are commonly encountered problems in the low birth weight (LBW) infant after delivery, and they may contribute to mortality and morbidity. Causes for the lactic acidosis are multiple and include maternal, placental and fetal factors. It is unclear whether metabolic acidaemia in the first 24 hours of life in LBW infants should be corrected by rapid infusion of alkali.

Objectives

The main objective was to assess the short and long-term effects of the rapid correction of early (first 24 hours) metabolic acidaemia in LBW (<2500g birth weight) neonates.

Search methods

Searches were undertaken of MEDLINE from February 2004 back to 1966 and the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 1, 2004). The title and abstract of each retrieved study were examined to assess eligibility. If there was uncertainty, the full paper was examined.

Selection criteria

Types of studies
All randomised controlled trials where short or long term effects of treatment with alkalising agents by rapid infusion were compared with placebo or no treatment, or where rapid infusion of alkalising agents was compared with slow infusion.

Types of participants
Newborn infants with birth weight <2500g and less than 24 hours of age with proven metabolic acidaemia (on arterial blood gas).

Types of interventions
Rapid correction of acidaemia with alkalising agents (sodium bicarbonate and/or THAM) given as a bolus over 5 minutes or less compared with either placebo, no intervention or slow infusion (>5 minutes).

Types of outcome measures
1) maximal oxygen requirement in first 24 hours
2) duration of oxygen therapy
3) need for and duration of assisted ventilation
4) intraventricular haemorrhage and/or periventricular leucomalacia
5) survival to discharge
6) long term survival (to 24 months of age)
7) neurological and developmental outcome at 24 months of age

Data collection and analysis

Each reviewer assessed eligibility, trial quality and extracted data separately, then compared and resolved differences. Study authors were contacted for additional information if necessary.

Main results

No studies were found meeting the criteria for inclusion in this review.

Authors' conclusions

There is no evidence available from randomised controlled trials to support or refute the rapid correction of metabolic acidaemia, in LBW infants in the first 24 hours of life, as compared with slow or no correction.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Rapid correction of early metabolic acidaemia in comparison with placebo, no intervention or slow correction in LBW infants

Plain language summary will be included with future update.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

快速矯正與給予安慰劑、沒有給予治療或緩慢矯正用於低出生體重嬰兒的代謝性酸血症

代謝性或混合性(代謝性和呼吸性)酸中毒是低出生體重嬰兒在出生後常常遇到的問題,而且可能會造成嬰兒死亡或產生病態。會造成乳酸性酸中毒的原因可能是多原因的,原因可能來自母體、胎盤或胎兒本身。低出生體重嬰兒在出生24小時內產生的代謝性酸血症,我們並不確定是否需要快速注射鹼來矯正。

目標

這篇文獻的主要目的是要評估對於低出生體重(<2500公克)新生兒的早期(在出生後24小時內)代謝性酸血症,在快速矯正後產生的短期及長期的效應。

搜尋策略

評論者所選取的的文獻包含MEDLINE從1966年至2004年2月份的文獻及Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 1, 2004)。評論者藉由評讀每一篇被擷取的文獻的標題及摘要,來判斷它們是否符合我們想要的標準。如果從評讀文獻的標題及摘要,不能確定是否符合我們想要的標準,評論者就會去評讀文獻的全文。

選擇標準

文獻類型 只要是比較快速注射鹼物質和給予安慰劑或沒有治療介入,或是比較快速注射鹼物質和慢速注射鹼物質的短期和長期效應的隨機控制研究,評論者皆收錄。 參予者的類型 新生兒出生體重小於2500公克,出生24小時內證實有代謝性酸血症(動脈血液氣體分析)。 介入的類型 在治療酸血症時是利用給予快速注射鹼物質(sodium bicarbonate或是THAM)達到快速矯正的目,與給與安慰劑、沒有治療介入或是緩慢注射(>5分鐘)鹼物質之間做比較。 測量結果的方法)出生24小時的內的最大需氧量)氧氣治療的時間)呼吸輔助器的需要及使用時間)腦室內出血及腦室旁白質軟化)出院時是否仍存活)長期存活率(追蹤至24個月大)在出生後24個月時的神經學及發展的結果

資料收集與分析

每位評論者都是獨立去評讀文章的是否符合本篇文獻所想要的資格、研究設計的品質以及得到的資料,然後再去比較及解決彼此間的差異性。如果需要的話,評論者會和文章的原作者做聯繫。

主要結論

在這篇評論中並沒有發現任何一篇符合符合評論者的選擇標準。

作者結論

並沒有任何來自隨機控制研究的證據,支持或反對對於治療低出生體重嬰兒於出生24小時內的代謝性酸血症應快速矯正、緩慢矯正或不用矯正。

翻譯人

本摘要由高雄醫學大學附設醫院陳怡瑄翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

概要仍等待中。