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• W2474837873 abstract "Behrman RE. J Pediatr 1966;69:173-4 At the end of the 1950s, James et al1James L.S. Weisbrot I.M. Prince C.E. Holaday D.A. Apgar V. The acid-base status of human infants in relation to birth asphyxia and the onset of respiration.J Pediatr. 1958; 52: 379-394Abstract Full Text PDF PubMed Scopus (129) Google Scholar and others had started measuring acid base balance in the newborn. Furthermore, Dawes et al2Dawes G.S. Jacobson H.N. Mott J.C. Shelley H.J. Stafford A. the treatment of asphyxiated, mature fetal lambs and rhesus monkeys with intravenous glucose and sodium carbonate.J Physiol. 1963; 169: 167-184Crossref PubMed Scopus (78) Google Scholar performed fundamental studies in using newborn lambs and monkeys with induced asphyxia. In a series of papers, the classical physiological changes were described including primary and secondary apneas and the initial increase in blood pressure and heart rate before a decline. These investigators also found that infusion of sodium bicarbonate or other buffers combined with glucose in fetal asphyxiated rhesus monkeys reduced the fall in heart rate, kept the blood pressure higher, and shortened the time to return of corneal reflexes than in untreated asphyxiated controls. However, lactate increased to much higher levels than in untreated animals. In addition, dangerously high pH (7.80) was observed in treated animals occasionally. These authors, therefore, warned against introducing buffer/glucose therapy to asphyxiated newborns because it “requires infusion of large volumes of strongly basic and hypertonic solutions,” However, the treatment soon became widespread. This is why Richard Behrman in the editor's column of The Journal 50 years ago cautioned against alkaline therapy in the delivery room underlining the possible inherent risks to the infant. Ahead of his time, he emphasized the need to conduct controlled human studies. Nevertheless, correction of acidosis in infants with respiratory distress syndrome and, as an adjunct, treatment of cardiac arrest and resuscitation after generalized circulatory collapse, were endorsed. These points have raised doubts. In the 1992, newborn resuscitation guidelines of the American Heart Association suggested that infusion of sodium bicarbonate may be beneficial during prolonged arrests that do not respond to other therapy. In 2000, the International Liaison Committee on Resuscitation modified these recommendations by stating that there is insufficient data to recommend routine use of bicarbonate in resuscitation of newborns. Behrman was a clairvoyant warning against the widespread clinical practice that was not based on experimental and clinical evidence. Even in an era of evidence-based medicine, we should still learn from Behrman's reminders and warnings 50 years ago." @default.
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• W2474837873 date "2016-07-01" @default.
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• W2474837873 title "50 Years Ago in The Journal of Pediatrics" @default.
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• W2474837873 doi "https://doi.org/10.1016/j.jpeds.2016.01.030" @default.
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