低出生体重儿的后期代谢性酸中毒

Late Metabolic Acidosis in Low-weight Neonatals

后期代谢性酸中毒(以下简称后期代酸Late Metabolic Acidosis)是指婴儿出生3天以后,无呼吸系统及消化系统并发症,能逐渐规律进食,正常排尿,但部分婴儿出现了某些临床症状和体征。血气分析中剩余硷(BE)达-7至-15mEq/l~1。

Blood gas of 26 low birth weight infants(LBW) who had no systemic complications were studied from 4th to 15th day after birth. Two or more blood gas analysis were done during hospitalization. LMA was diagnosed by base excess(BE) equal or below 7mEq/l. The average weight of the infants was 1840g and the average gestational age was 247 days(35-2/7-wks). Among the 26 infants, 22 of them had LMA, with an incidence of 84.6%. A significant reduction of BE appeared by 8.6th days in average and the maxium fall being reached 9.6 days in average. Clinical symptoms and signs include cyanosis, lethargy, and watery stools etc. We suggest that relatively healthy babies present the above symptoms by the end of first week of life after birth, even without blood gas analysis, LMA should be highly suspected. In this condition we prefer to provide supplemental dose of NaHCOat least 5mEq/kg/d in addition to the normal requirement of Na 3 mEq/kg/d. The predisposing factors of this disorder were also discussed in this paper.