Intensive Care Medicine

, Volume 19, Issue 2, pp 65–69 | Cite as

Hemodynamic effects of sodium bicarbonate in critically ill neonates

  • S. Fanconi
  • R. Burger
  • D. Ghelfi
  • J. Uehlinger
  • U. Arbenz
Neonatal and Pediatric Intensive Care Original



To analyze the cardiovascular effects of sodium bicarbonate in neonates with metabolic acidosis.


Prospective, open, non-randomized, before-after intervention study with hemodynamic measurements performed before and 1, 5, 10, 20, and 30 min after bicarbonate administration.


Neonatal intensive care unit, tertiary care center.


Sequential sample of 16 paralysed and mechanically ventilated newborn infants with a metabolic acidosis (pH<7.25 in premature and <7.30 in term infants, base deficit>−8).


An 8.4% sodium bicarbonate solution diluted 1∶1 with water (final osmolality of 1000 mOsm/l) was administered in two equal portions at a rate of 0.5 mmol/min. The dose in mmol was calculated using the formula “base deficit x body weight (kg)×1/3×1/2”.

Measurements and results

Sodium bicarbonate induced a significant but transient rise in pulsed Doppler cardiac output (CO) (+27.7%), aortic blood flow velocity (+15.3%), systolic blood pressure (BP) (+9.3%), (+14.6%), transcutaneous carbon dioxide pressure (PtcCO2) (+11.8%), and transcutaneous oxygen pressure (PtcO2) (+8%). In spite of the PaCO2 elevation, pH significantly improved (from a mean of 7.24 to 7.30), and the base deficit decreased (−39.3%). Calculated systemic vascular resistance (SVR) (−10.7%) and diastolic BP (−11.7%) decreased significantly, while PaO2 and heart rate (HR) did not change. Central venous pressure (CVP) (+6.5%) increased only slightly. By 30 min after bicarbonate administration all hemodynamic parameters, with the exception of the diastolic BP, had returned to baseline.


Sodium bicarbonate in neonates with metabolic acidosis induces an increase in contractility and a reduction in afterload.

Key words

Sodium bicarbonate Neonates Metabolic acidosis Hemodynamics Pulsed Doppler Cardiac output 


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Copyright information

© Springer-Verlag 1993

Authors and Affiliations

  • S. Fanconi
    • 1
  • R. Burger
    • 1
  • D. Ghelfi
    • 1
  • J. Uehlinger
    • 1
  • U. Arbenz
    • 2
  1. 1.Intensive Care UnitUniversity Children's HospitalZürichSwitzerland
  2. 2.Department of CardiologyUniversity Children's HospitalZürichSwitzerland

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