EC Paediatrics

Background: Neonatal mortality rate is one of the key indicator in the health status of a nation, and directly reflects prenatal, intra-partum, and neonatal care.

Aim of this study: To find out the association of electrolyte and acid base disorder in critically sick neonates at the time of admission in NICU as predictor of their mortality.

Methods: This retrospective study was conducted in the department of Neonatology, Bangladesh Shishu Hospital and Institute (BSHandI), Sher-E-Bangla Nagar, Dhaka, from January 2023 to June 2023. Total 115 neonates were included in this study having serum electrolyte and arterial blood gas with other basic biochemical parameter analyzed at the time of admission.

Results: Blood pH, HCO₃^-, Base excess were lower, Sodium (Na⁺) level and anion gap were higher in non-survivors than survivors group which were statistical significant (p < 0.05). No statistical significant different regarding PCO₂, PO₂, potassium (K⁺) and chloride level (p > 0.05). Multivariable logistic regression analysis identified a higher AG (OR 1.321, 95% CI 1.14-1.53; p < 0.001) at the time of admission in NICU as predictor of mortality.

Conclusion: A higher AG (anion gap) at the time of admission in NICU identified as strongest predictor of mortality.

 Keywords: NICU; Electrolyte and Acid-Base Disorder; Mortality Predictor

1. James LS., et al. “The acid-base and electrolyte status of human infants in relation to birth asphyxia and the onset of respiration”. The Journal of Pediatrics4 (1958): 379-394.
2. Brouillette RT and Waxman DH. “Evaluation of the newborn’s blood gas status”. American Association for Clinical Chemistry1 (1997): 215-221.
3. Gunnerson KJ. “Clinical review: The meaning of acid-base abnormalities in the intensive care unit Part I epidemiology”. Critical Care5 (2005): 508-516.
4. Orozco-Gregorio H., et al. “Importance of blood gas measurements in perinatal asphyxia and alternatives to restore the acid-base balance status to improve the newborn performance”. American Journal of Biotechnology and Biochemistry3 (2007): 131-140.
5. Abelow B. “Understanding Acid-base”. In: Williams and Wilkins, 2^nd USA 52 (1998): 210-216.
6. Deorori AK. “Blood gas analysis”. AIIMS 3 (2008): 1-41.
7. Cole CH., et al. “Resolving our uncertainty about oxygen therapy”. Pediatrics 6 (2003): 1415-1419.
8. Otieno H., et al. “Are bed side features of shock reproducible between different observers?” Archives of Disease in Childhood 10 (2004): 977-979.
9. Fencl V., et al. “Diagnosis of metabolic acid-base disturbances in critically ill patients”. American Journal Respiratory in Critical Care Medicine6 (2000): 2246-2251.
10. Barkovich AJ and Truwit CL. “Brain damage from perinatal asphyxia: correlation of MR findings with gestational age”. American Journal Neuroradiology6 (1990): 1087-1096.
11. Rao SDS and Thomas B. “Electrolyte imbalance in children admitted to intensive care unit”. Indian Pediatric 37 (2000): 1348-1353.
12. Kathryn ER. “Paediatric fluid and electrolyte balance: Critical care case studies”. Critical Care Nursing Clinics of North America 4 (2005): 361-373.
13. Rees L., et al. “Hyponatremia in the first week of life in preterm infants (Part I Arginine vasopressin secretion)”. Archives of Disease in Childhood 5 (1984): 414-422.
14. Harkness RA. “Clinical biochemistry of the neonatal period: immaturity, hypoxia and metabolic disease”. Journal of Clinical Pathology9 (1987): 1128-1144.
15. Berry PL and Belsha CW. “Hyponatremia”. Pediatric Clinics of North America 2 (1990): 351-363.
16. Conley SB. “Hypernatremia”. Pediatric Clinics of North America 2 (1990): 365-371.
17. Linshau MA. “Potassium homeostasis and hypokalemia”. Pediatric Clinics of North America 3 (1987): 649-681.
18. Yuan HC., et al. “Hyperkalemia during the early postnatal days in premature infants”. Acta Paediatrica Taiwanica 4 (2003): 208-214.
19. Kaplan LJ., et al. “Initial pH, base deficit, anion gap, strong ion difference and strong ion gap predict outcome from major vascular injury”. Critical Care Medicine5 (2004): 1120-1124.
20. Sahu A., et al. “The initial anion gap is a predictor of mortality in acute myocardial infarction”. Coronary Artery Disease 5 (2006): 409-412.
21. Smith I., et al. “Base excess and lactate as prognostic indicators for patients admitted for intensive care”. Intensive Care Medicine 1 (2001): 74-83.
22. Levraout J., et al. “Reliability of anion gap as an indicator of blood lactate in critically ill patients”. Intensive Care Medicine4 (1997): 417-422.
23. Palsdottir K., et al. “Birth asphyxia, neonatal risk factors for hypoxic ischemic encephalopathy”. Laeknabladid 10 (2007): 669-673.
24. Hermanson MC. “The acidosis paradox in asphyxia brain injury without coincident acidemia”. Developmental Medicine and Child Neurology 5 (2003): 353-356.
25. Ahmad I., et al. “Acid-base disorders in critically ill neonatal ICU patients and predicting survival by the presence of deranged Acid-Base variables”. Journal of Neonatal Biology 5 (2015): 207-215.
26. Lekhwani S., et al. “Acid-base disorders in critically ill neonates”. Indian Journal of Critical Care Medicine 2 (2010): 65-69.
27. Horacio JA and Nicolos EM. “Management of life threating acid base disorders”. New England Journal of Medicine 1 (1998): 26-34.
28. Orsido TT., et al. “Predictors of Neonatal mortality in Neonatal Intensive Care Hospital at referral Hospital in Southern Ethiopia: A retrospective cohort study”. BMC Pregnancy and Childbirth1 (2019): 83.
29. Afify MF., et al. “Corrected anion gap and hyponatremia as predictors of mortality in Pediatric Intensive care Unit, Minia University Hospital: A Retrospective study”. International Journal of Pediatrics10 (2020): 12369-12379.
30. , et al. “Admission anion gap metabolic acidosis and its impact on patients in medical intensive care unit”. Journal of Laboratory Physicians 13.2 (2021): 107-111.
31. , et al. “Serum anion gap at admission as a predictor of mortality in the pediatric intensive care unit”. Scientific Reports 7.1 (2017): 1456.