What is the role of sodium bicarbonate in the treatment of persistent pulmonary hypertension of the newborn (PPHN)?

Updated: Sep 03, 2019
  • Author: Kate A Tauber, MD; Chief Editor: Howard S Weber, MD, FSCAI  more...
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Answer

Acidosis can act as a pulmonary vasoconstrictor and should be avoided. The use of sodium bicarbonate was common prior to the approval of iNO. [39] Previous studies have shown that the pulmonary vascular response to alkalosis is transient, and prolonged alkalosis may paradoxically worsen pulmonary vascular tone, reactivity, and permeability leading to edema. [40] Further, alkalosis causes cerebral constriction and reduces cerebral blood flow and oxygen delivery to the brain and thus might be associated with worse neurodevelopmental outcomes.

Currently, there is no evidence suggesting that using sodium bicarbonate infusions to induce alkalosis provides any short- or long-term benefit. [39]

Some still advocate using sodium bicarbonate infusions to maintain an alkaline pH. Serum sodium concentration should be carefully monitored if bicarbonate infusions are used, and ventilation must be adequate to allow for carbon dioxide clearance.

Walsh-Sukys et al reported that the use of alkaline infusion is associated with an increased need for ECMO when the newborn is aged 28 days. [39] Therefore, use this approach with caution.

Many clinicians have good success without using alkalinization. In a series of 15 patients, Wung et al applied a strategy designed to maintain PaO2 at 50-70 mm Hg and PaCO2 at less than 60 mm Hg (ie, gentle ventilation). [41] This approach resulted in excellent outcomes and a low incidence of chronic lung disease.


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