title: A survey of intravenous sodium bicarbonate in neonatal asphyxia among European neonatologists: gaps between scientific evidence and clinical practice.
abstract: BACKGROUND
  Birth asphyxia is characterized by intermittent periods of hypoxia/ischemia leading to metabolic acidosis. The use of intravenous sodium bicarbonate (IVSB) is still a matter of controversy in clinical practice.
  
  
  OBJECTIVE
  To assess the use of IVSB in birth asphyxia by attending neonatologists in European hospitals.
  
  
  METHODS
  Survey using a questionnaire administered to neonatologists in Europe whose electronic addresses were provided by the national councils of neonatology of each participating country. The questionnaire consisted of a brief theoretical introduction followed by demographic questions related to the respondent's professional qualification. This was followed by a clinical case of an asphyxiated term neonate with severe combined metabolic and respiratory acidosis and case-specific questions related to the perceived indication for administration of IVSB and use of additional therapies to address the clinical situation. Descriptive statistics and χ² analysis were performed.
  
  
  RESULTS
  The questionnaire was answered by 259 neonatologists from 17 countries. IVSB was believed to be indicated by 109 (42.2%) of the respondents in this clinical scenario. Results differed significantly between countries, with IVSB use varying from as high as 68% in Portugal and <5% in Scandinavian countries. However, there were no differences in the choice of other therapeutic measures.
  
  
  CONCLUSIONS
  Although scientific evidence suggests that IVSB is not effective in asphyxiated newborns and current guidelines do not recommend its use, 42.2% of the consulted neonatologists in Europe would use it, with significant differences between but not within countries. There were no differences regarding additional measures to overcome asphyxia. Strategies to implement use of internationally accepted guidelines are needed.
authors.affiliation: Division of Neonatology, University Hospital La Fe, Valencia, Spain.
authors.forename: Pilar
authors.initials: P
authors.lastname: Sáenz
authors.forename: Maria
authors.initials: M
authors.lastname: Brugada
authors.forename: Beatriz
authors.initials: B
authors.lastname: de Jongh
authors.forename: Augusto
authors.initials: A
authors.lastname: Sola
authors.forename: Ester
authors.initials: E
authors.lastname: Torres
authors.forename: Lucas
authors.initials: L
authors.lastname: Moreno
authors.forename: Máximo
authors.initials: M
authors.lastname: Vento
mesh_terms: D000138:Acidosis / Q000188:drug therapy / Q000378:metabolism; D000142:Acidosis, Respiratory / Q000188:drug therapy / Q000378:metabolism; D001238:Asphyxia Neonatorum / Q000188:drug therapy* / Q000378:metabolism; D005060:Europe; D006801:Humans; D007231:Infant, Newborn; D007262:Infusions, Intravenous; D010818:Practice Patterns, Physicians'; D017693:Sodium Bicarbonate / Q000008:administration & dosage*; D011795:Surveys and Questionnaires
chemical_list: D017693:Sodium Bicarbonate