Sodium Bicarb

[Katie_nicuRN]

I'm curious if your unit uses Sodium Bicarbonate to treat metabolic acidosis. My understanding was that this is an outdated practice (I've never given it in my 6 years of NICU nursing) but the new unit I just started on gives it ALL the time.

[meanmaryjean, DNP, RN]

It really depends on the physician. In PICU we give it frequently. bicarb down the ETT is outdated, bicarb IS the standard treatment for metabolic acidosis. it's not 'outdated'.

[EricJRN, MSN, RN]

It's not outdated, but I think one confusing thing is that it has been deemphasized in NRP for many years. (Bicarb was a standard code drug for a long time, but now it's known that in coding neonates, there is usually respiratory acidosis, and bicarb will just raise the pCO2 and lower the pH in that situation.)

In metabolic acidosis, bicarb is still often indicated, but it's also important to look at correctable causes of metabolic acidosis, like whether the baby is cold, fluid-depleted or perfusing poorly.

[NICUNurseEliz]

We give bicarb for prolonged metabolic acidosis (base excess usually less than

Our unit used to hang bicarb drips fairly frequently but I haven't seen one in several years now.

[babyNP., APRN]

Sodium bicarbonate use in the NICU has declined over the last few years and it is outdated depending on what you are trying to do (I've seen it still being used for hyperkalemia in order to drive potassium temporarily into the cell). When looking at different practices and trying to determine the efficacy, it's best to do a literature search to see what the data shows. Unfortunately, there is not a lot of research out there on the neonate as compared to the adult population.

There is some data on sodium bicarb here from the WHO regarding its use during resuscitation: WHO | Sodium bicarbonate infusion during resuscitation of infants at birth

Their conclusion is basically that it's not useful during resuscitation. Although it's not conclusively proven, they feel that the evidence is strong enough to recommend *not* doing more RCTs in order to determine its efficacy.

Here's an article discussing the risk of IVH with using it with preemies: Beware of Sodium Bicarbonate Infusions in Premature Infants - NEJM Journal Watch

All in all, it's hard to not give something to a baby that's dying right in front of you and as a provider, you want to be able to know that you've done everything that you can. But the reality is that it just doesn't work as well as we would like it to, comes with significant risks, and doesn't really change outcomes. What you really need to do is figure out why a baby is acidotic in order to treat the actual cause. Unfortunately, when it's something like severe HIE, there's nothing that you could do anyway to change the outcome (cooling only helps prevent future brain injury, not help any injury that already occurred).

[Yesutor]

Really , I have no idea at all.

thank you all for the information.

[NICU_RNC, BSN, RN]

I can't remember the last time we gave Sodium Bicarb here... It increases the risk of IVH so use sparingly.

[littlepeopleRNICU]

It's not outdated, but I think one confusing thing is that it has been deemphasized in NRP for many years. (Bicarb was a standard code drug for a long time, but now it's known that in coding neonates, there is usually respiratory acidosis, and bicarb will just raise the pCO2 and lower the pH in that situation.)

In metabolic acidosis, bicarb is still often indicated, but it's also important to look at correctable causes of metabolic acidosis, like whether the baby is cold, fluid-depleted or perfusing poorly.

What he said. We give bicarb VERY frequently, but depending on cause, may give an LR(usually) or NS bolus first.