Intervention Review

Sodium bicarbonate infusion during resuscitation of infants at birth

  1. Catriona JE Beveridge*,
  2. Andrew R Wilkinson

Editorial Group: Cochrane Neonatal Group

Published Online: 25 JAN 2006

Assessed as up-to-date: 29 SEP 2005

DOI: 10.1002/14651858.CD004864.pub2


How to Cite

Beveridge CJE, Wilkinson AR. Sodium bicarbonate infusion during resuscitation of infants at birth. Cochrane Database of Systematic Reviews 2006, Issue 1. Art. No.: CD004864. DOI: 10.1002/14651858.CD004864.pub2.

Author Information

  1. John Radcliffe Hospital, Department of Paediatrics, Oxford, UK

*Catriona JE Beveridge, Department of Paediatrics, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK. cattybeveridge@hotmail.com.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 25 JAN 2006

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Abstract

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

Background

For many years, intravenous sodium bicarbonate has been used to reverse acidosis during newborn resuscitation. However, controversy surrounds its use. Most of the evidence has been derived from studies in animals, adult humans, or in uncontrolled, descriptive experiments. Despite the lack of evidence from the human neonatal population and concerns about its safety, some international resuscitation guidelines still recommend the use of sodium bicarbonate in resuscitation of the newborn.

Objectives

To determine whether an intravenous infusion of sodium bicarbonate, compared to placebo or no treatment, reduces mortality and morbidity (in particular regarding neurodevelopmental outcome) in infants receiving resuscitation in the delivery room at birth.

Search methods

We used the standard search strategy of the Cochrane Neonatal Review Group. Searches were conducted of the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 3, 2005), MEDLINE (1966 - September 2005), EMBASE (1980 - September 2005) and CINAHL (1982 - September 2005) and Pediatric Research (1987 - September 2005). Unpublished trials were sought by handsearching the conference proceedings of American Pediatric Society/Society for Pediatric Research (1990 - 2005) and European Society for Paediatric Research (1993 - 2005).

Selection criteria

Randomised or quasi-randomised controlled trials of newborn infants receiving sodium bicarbonate infusion during any resuscitation in the delivery room at birth.

Data collection and analysis

Two review authors independently assessed trial quality and extracted data. Study authors were contacted for additional information.

Main results

We found one randomised controlled trial that fulfilled the eligibility criteria (Lokesh 2004) that compared treating asphyxiated newborn infants (infants continuing to need positive pressure ventilation at 5 minutes after birth) with sodium bicarbonate infusion (N = 27) versus 5% dextrose (N = 28). They found no evidence of an effect on mortality prior to discharge [Relative risk 1.04 (95% confidence interval 0.49 to 2.21)], abnormal neurological examination at discharge [Relative risk 0.86 (95% confidence interval 0.30 to 2.50)] or a composite outcome of death or abnormal neurological examination at discharge [Relative risk 0.97 (95% confidence interval 0.59 to 1.60)]. There was no statistically significant difference in the incidence of encephalopathy [Relative risk 1.30 (95% confidence interval 0.88 to 1.92)], intraventricular haemorrhage [Relative risk 1.04 (95% confidence interval 0.23 to 4.70)] and neonatal seizures [Relative risk 1.19 (95% confidence interval 0.50 to 2.82)]. No long term neurodevelopmental outcomes were assessed.

Authors' conclusions

There is insufficient evidence from randomised controlled trials to determine whether the infusion of sodium bicarbonate reduces mortality and morbidity in infants receiving resuscitation in the delivery room at birth.

 

Plain language summary

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

Sodium bicarbonate infusion during resuscitation of infants at birth

Intravenous infusion of sodium bicarbonate to newborn babies during resuscitation in the delivery room at birth. At birth some babies who do not start breathing spontaneously have an abnormal amount of acid in their blood. To treat this, an alkaline drug, sodium bicarbonate, has often been given intravenously. Although this has been common practice for over thirty years, there is no good evidence that this is beneficial and may cause harm. We found only one high quality study of 55 babies that compared sodium bicarbonate treatment with no treatment. The study did not show any benefit of the use of this drug immediately after birth, nor any adverse effects.

 

摘要

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

背景

新生兒出生時急救過程使用重碳酸氫鈉輸注

許多年來,從靜脈給予重碳酸氫鈉輸注常被用來改善在新生兒急救過程當中所發生的酸中毒。然而,對於重碳酸氫鈉的使用仍有諸多爭議。大部分的證據來自動物實驗,成人或者是非經控制組對照組的敘述性實驗。儘管缺乏人類新生兒族群的證據支持及對其安全性的考量,一些國際急救準則仍然建議在新生兒急救過程給予重碳酸氫鈉。

目標

判定使用靜脈重碳酸氫鈉輸注,比起安慰劑或不治療,對於那些在出生時就在產房施行急救的新生兒,能否更能降低死亡率及罹病率(特別是在神經發展的結果)。

搜尋策略

我們使用 Cochrane Neonatal Review Group的標準搜尋策略,在Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 3, 2005) EDLINE (1966  September 2005), EMBASE (1980  September 2005) and CINAHL (1982  September 2005) and Pediatric Research (1987  September 2005)搜尋結果。尚未發表的臨床試驗則是從American Pediatric Society/Society for Pediatric Research (1990 – 2005)和European Society for Paediatric Research (199  2005)所進行的研討會中搜尋

選擇標準

研究在出生時就在產房施行急救的新生兒接受重碳酸氫鈉輸注的隨機或近似隨機臨床控制實驗

資料收集與分析

兩位獨立的評論者評估試驗的品質及篩選資料。並與該研究作者聯繫以取得額外資訊。

主要結論

我們發現有一個臨床控制實驗符合我們所訂的標準(Lokes 004) ,該研究比較重碳酸氫鈉輸注(樣本數=27)與5%葡萄糖水輸注(樣本數=28)用於治療缺氧窒息的新生兒(定義為:在出生5分鐘之後仍然持續需要正壓呼吸),發現重碳酸氫鈉輸注在降低出院前死亡率(相對危險因子1.04,95%信賴區間0.49 – 2.21)、出院時神經學檢查異常(相對危險因子0.86,95%信賴區間0.3 – 2.5)、及兩者綜合評估(相對危險因子0.97,95%信賴區間0.59 – 1.6)均無顯著效用。使用重碳酸氫鈉輸注對於是否發生腦病變(相對危險因子1.3,95%信賴區間0.88 – 1.92)、腦室內出血(相對危險因子1.04,95%信賴區間0.23 – 4.70)及新生兒痙攣(相對危險因子1.19,95%信賴區間0.5 – 2.82)均無統計學上顯著差異。對長期神經發展並無評估。

作者結論

對於那些在出生時就在產房施行急救的新生兒,使用靜脈重碳酸氫鈉輸注是否更能降低死亡率及罹病率,從目前的隨機控制臨床試驗中,證據仍顯不足。

翻譯人

本摘要由高雄醫學大學附設醫院郭昶宏翻譯。

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

總結

對於那些在出生時就在產房施行急救的新生兒,特別那些因為無法開始自發性呼吸而導致酸血症的嬰兒,靜脈輸注鹼化藥物(重碳酸氫鈉)是常見的治療方式。雖然超過三十年靜脈輸注重碳酸氫鈉使用得相當普遍,對於其益處仍未有良好證據,且可能存在潛在傷害。我們只有找到一個樣本為55個嬰兒的高品質研究,比較靜脈輸注重碳酸氫鈉與不治療的差異。該研究並未顯示在出生後立即給予靜脈輸注重碳酸氫鈉有任何益處,但也沒有任何不良效果。