Aidsis
Intdtin
Aidaemia is mmn in nenates espeiay in assiatin with pematity and peinata asphyxia. It is essentia t estabish whethe the aidaemia is espiaty with a aised Pa2 , metabi with a nma Pa2 bt a negative base exess, a mbinatin f bth. Metabi aidsis in petem infants may be assiated with hypxaemia, hyptensin p tisse pefsin, anaemia, infetin sepsis, stens ativity (espiaty distess).
A ate metabi aidsis may devep in pemate infants that eeive high ptein amin aid intakes. This may be exaebated by eded eabsptin f biabnate fm the pxima tbes and eded new base fmatin by the kidneys f pemate infants.
This gideine deas with pstnata aidsis. See essitatin f aidsis at bith.
Inidene and isk fats
Gdabe1 stdied 30,000 nsetive deiveies and fnd a d pH < 7.2 ed in 3506 infants (11.7%), pH < 7.1 in 472 (1.6%), and pH < 7.0 in 87 (0.3%). The inidene f pstnata aidsis has nt been dmented in the vea ppatin f nenates bn at KGV Hspita. In a ht f petem infants bn at KGV the inidene f pstnata aidsis in the fist 48h f ife by gestatin wee:
Gestatin (weeks) pH < 7.20 Base exess < -10
23 t 25 18% 26%
26 t 27 28% 19%
28 t 29 11% 14%
Imptant ases f aidsis in nenates:
Peinata asphyxia
Sepsis
espiaty distess
Hypvaemia
w adia tpt and p tisse pefsin
Hypthemia
Anaemia
ena biabnate sses
adia faie ngenita adia anmaies
Inbn e f metabism
nseqenes
Thee is an assiatin between aidsis, ate physigia dysfntin in the nenate and nge tem nedevepmenta abnmaities. Whethe the aidsis is asative ny assiated with ate gan dysfntin and abnma nedevepment is ess etain. The fwing assiatins with aidsis have been dmented:
Sht tem:
Aidaemia assiated with asphyxia inhibits sfatant pdtin2, 3 and ineases pmnay vasa esistane4. A pH < 7.15 is assiated with eded myadia ntatiity5 and diaphagmati ativity (in dgs 6). EEG dmented abnma eeba fntin has been shwn in petem infants < 32 weeks gestatin in eatin t episdes f aidsis7.
Hydgen ins ase the peipitatin f biibin aid. Aidsis my exaeabat:e kenites. This shd be taken int ant in the teatment f hypebiibinaemia
nge tem
Thee is an assiatin between nenata aidsis and evidene f end-gan damage fm peinata asphyxia inding hypxi ishaemi enephaathy. In the seies f 30 000 infants f Gdebe1, the inidene f nenata death and nenata seizes did nt inease nti a pH < 7.05 was eahed. The abste inidene f thewise nexpained nenata seizes was 1.1% f pH < 7.05 and 9.2% f pH < 7.00. The mtaity ineased t 1.1% f pH < 7.05 and 8% at a pH < 7.00.
In petem infants thee is an assiatin between a w mbiia ateia pH and sbseqent abnma nedevepmenta tme in extemey w bith weight infants8.
Diagnsis
Deteminatin f aid-base stats may be made by:
Ateia bd gas - d mbiia atey at deivey, mbiia ateia ine, peiphea ateia ine ateia pnte pst deivey.
apiay bd gas - me aate at detemining pH, ess aate f P2 and inaate at pediting ateia P2. ests shd be sed with atin 9.
It is essentia t estabish whethe the aidaemia is espiaty with an eevated Pa2 metabi with a nma Pa2 bt a negative base exess, a mbinatin f bth.
Aidsis may be:
espiaty: w pH, high Pa2, and high H3
Metabi: w pH, negative base exess
Mixed metabi and espiaty: w pH, high Pa2 and negative base exess mst feqent in pemate infants)
mpensated espiaty: nea nma pH, high Pa2, high base exess and nea nma H3
mpensated metabi: nea nma pH, w Pa2, negative base exess and w H3
Estabishing the ndeying ase f the aidsis may be assisted by:
Histy - evidene f feta distess, isk fats f sepsis, pematity
Examinatin - espiaty distess, adia disease, p peiphea pefsin, pa (anaemia), hyptensin, nsa ds (metabi disease),
Sem Na, K, , and biabnate (n ABG) t detemine anin gap = ([Na + K] -[ + H3])
Bd atate t nfim ati aidsis
Metabi seen: ine and sem f amin aids and gani aids
Bd nt - sepsis, anaemia
Bd tes - sepsis
EH - w adia tpt
Inteventins
espiaty aidsis shd be eted by manipatin f the ventiatin. Nmabia (Pa2 35-45 mmHg) shd be the aim f ventiaty management. Biabnate theapy given t a hypeabi baby may wsen the hypeabia as we as inease eeba aidsis (anima and adt data eviewed by Hwe10).
Metabi aidsis is mst ften eted by attentin t its ase. Hypabia shd nt be pded when teating a metabi aidsis.
Biabnate theapy:
nside teatment with akai in infants if pH < 7.20 and a metabi aidsis is pesent (w pH and high base defiit). The evidene f se f akai theapy in pemate infants with espiaty distess is eqiva. Sevea stdies have attempted t demnstate the effet f teatment f eay aidsis in infants (say pH < 7.25) with DS and shwn diffeing ests11, 12, 13.
Whethe etin f sevee aidsis impves tmes has nt been stdied in a andmized tia.
Give biabnate theapy ve 30-60 mintes. Sinai11 stdied apid (<5 mintes) vess sw biabnate theapy (ve 24 hs) and fnd a tend t ineased mtaity in the apid gp and n benefit in tems f time t etin f pH. In view f expeienes with apid infsins f biabnate esting in an ineased inidene f intaventia haemhage14, 15, 16 (nn-andmised stdies) and anima data sggesting hamf effets (eviewed by Hwe 10) apid infsins f biabnate shd be avided whee pssibe.
Akainisatin f tta paentea ntitin:
Aetate shd be added t tta paentea ntitin f infants with a base defiit ≥ 5. Pemate infants with ate metabi aidsis have bette weight gain and highe nitgen assimiatin if given NaH3 mpaed t saine17, and the se f aetate in tta paentea ntitin f pemate infants edes the seveity f the aidsis and inidene f hypehaemia18.
Biabnate theapy f essitatin:
THAM (tis-hydxymethyaminmethane):
THAM is nt avaiabe in Astaia. This akai has the ptentia advantages f nt asing hypenataemia and hypeabia. Hweve, it pvides a highe sma ad in eqima dses t sdim biabnate and ased depessin f ventiatin and hypgyaemia. It has nt been sbjeted t andmised tias.
If a deisin is made t et the metabi aidsis sing base, sdim biabnate is sed in the fwing amnt. emembe that epeated infsin f sdim biabnate may ase hypenataemia. Haf etin shd be aimed at and epeated if neessay. se sdim biabnate 8.4% and dite 50:50 with wate (= 4.2%).
F haf etin:
4.2% NaH3 (m) = weight (kg) x base defiit x 0.3
Administe ve 30-60 mintes.
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