Correction of Acidosis in Neonatal Intensive-care Medicine: A National Survey

Background: Metabolic acidosis is a common problem of patients on neonatal intensive care units. Only little data exists in literature and there are no clinical guidelines. The aim of this national survey was to assess criteria for correction of metabolic acidosis in neonatal patients and if there were effects to be observed. Methods: We designed an online survey and sent it to 304 German children's hospitals. 101 questionnaires were included in our study. Results: The question "How often do you buffer on your ward a week?" was answered 63 times with "zero". In perinatal asphyxia newborns with gestation age over 36 + 0 weeks 4 % of the neonatologists would frequently perform a correction of acidosis, 74.3 % would do it rarely and 21.8 % never. In syndrome of persistent fetal circulation 28.4 % would correct acidosis frequently, 42.0 % would correct it rarely and 29.5 % would never correct it. In case of sepsis 8.7 % would correct acidosis frequently, 70.7 % would do it rarely and 20.7 % would never correct it. 75.2 % of the participants distinguish in buffering a premature or a mature infant. 44.4 % of neonatologists saw an improvement of the clinical status of the patient after buffering. 38.3 % saw different effects, 16.0 % saw no changes and 1.2 % saw a worsening of the clinical status. 49.4 % of those questioned saw side effects after using sodium bicarbonate as a buffer. Conclusion: Correction of acidosis with a buffer is rarely performed on German neonatology wards. The indication of buffering depends on the clinical picture and its underlying problem. Benefits from buffering were seen, as well as side effects.