Hydrogen Ion Balance in the Neonate

  • G. Zilleruelo
  • S. Sultan
  • E. Bancalari
  • B. Steele
  • J. Strauss
Chapter
Part of the Developments in Nephrology book series (DINE, volume 6)

Abstract

It is well known that neonates, particularly low, birth weight (LBW) infants, tend to develop acidosis (l–3). The relation between maturity and degree of metabolic acidosis in the perinatal period and in early infancy is still controversial. Direct correlation between LBW and metabolic acidosis has been found by some investigators (4,5) but not by others (6). Using adult standards, renal “immaturity” has been described for many functions of the neonatal kidney including the renal acidification mechanisms (7). However, results obtained from acid-base studies in the neonatal period are particularly difficult to evaluate due to the multiplicity of factors involved (Table 1). Among these factors are: different birth weights; gestational and postnatal ages; different clinical situations such as acidotic (acute vs chronic, spontaneous vs induced) vs non-acidotic; different dietary conditions (breast milk vs cow’s milk, fasting, etc). In addition, methodological and technical problems in obtaining urine and blood samples make even more difficult the evaluation of results obtained in this age group. Other factors such as perinatal events, environmental temperature and growth rate, may also influence acid-base equilibrium. In this paper, we will review some concepts about normal acid-base physiology and the response obtained in the neonate with metabolic acidosis at different gestational ages.

Keywords

Phosphorus Creatinine Titration Acidity Ketone 

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References

  1. 1.
    Bucci, G., Salamandre, A., Savignoni, P.G. and Medicini, M.: Acid-base status of normal premature infants in the first week of life. Biol. Neonat. 8:81, 1965.Google Scholar
  2. 2.
    Malan, A.F., Evans, A. and Heese, H. de V.: Serial acid-base determinations in normal premature and full term infants during the first 72 hours of life. Arch. Dis. Childh. 40: 645, 1965.PubMedCrossRefGoogle Scholar
  3. 3.
    Kildeberg, P.: Disturbances of hydrogen ion balance occurring in premature infants. I. Early type of acidosis. Acta Paediat. Scand. 53: 505, 1964.CrossRefGoogle Scholar
  4. 4.
    Malan, A.F., Evans, A. and Heese H. de V.: Acid-base determinations in normal premature infants in the first two months of life. Arch. Dis. Childh. 41: 678, 1966.PubMedCrossRefGoogle Scholar
  5. 5.
    Sulyok, E., Heim, T., Soltesz, G. and Jaszai, V.: The influence of maturity on renal control of acidosis in newborn infants. Biol. Neonat. 21: 418 1972.CrossRefGoogle Scholar
  6. 6.
    Schain, R.J. and O’Brien, K.: Longitudinal studies of acid-base status in infants with low birth weight. J. Pediatr. 70: 885, 1967.PubMedCrossRefGoogle Scholar
  7. 7.
    Edelman, C.M., Jr. and Spitzer, A.: The maturing kidney. A modern view of well-balanced infants with imbalanced nephrons. J. Pediat. 75: 509, 1969.CrossRefGoogle Scholar
  8. 8.
    Chan, J.C.M.: Renal acidosis. In Duarte, C.G. (ed.): Renal Function Tests. Clinical Laboratory Procedures and Diagnosis. Boston Little,Brown and Co., 1980, p. 239Google Scholar
  9. 9.
    Kildeberg, P.: Late metabolic acidosis of premature infants. In Winters, R.W. (ed): The Body Fluids in Pediatrics. Boston: Little, Brown and Co., 1973, p. 338.Google Scholar
  10. 10.
    Chan, J. C.M.: Hydrogen ion production secondary to metabolism of sulfur aminoacids and organic acids. Nutr. Metab. 22: 288, 1978.PubMedCrossRefGoogle Scholar
  11. 11.
    Rector, F. C., Jr. and Cogan, M.G.: The renal acidosis. Hospital Practice 15: 99, 1980.PubMedGoogle Scholar
  12. 12.
    Rector, F.C., Jr., Carter, N. and Seldin, D.W.: The mechanisms of bicarbonate reabsorption in the proximal and distal tubules of the kidney. J. Clin. Invest. 44: 278, 1965.PubMedCrossRefGoogle Scholar
  13. 13.
    Cogan, M.G., Maddox, D.A., Lucci, M.S. and Rector, F.C., Jr.: Control of proximal bicarbonate reabsorption in normal and acidotic rats. J. Clin. Invest. 64: 1168, 1979.PubMedCrossRefGoogle Scholar
  14. 14.
    Cogan, M.G., Maddox, D.A., Warnock, D.G. et al.: Effect of acetazolamide on bicarbonate reabsorption in the proximal tubule of the rat. Am. J. Physiol. 237: 447, 1979.Google Scholar
  15. 15.
    Rector, F.C., Jr.: Acidification of the urine. In Orloff, J. and Berliner, R. (eds.): Handbook of Physiology. Baltimore: Williams and Wilkins, 1973, p. 431.Google Scholar
  16. 16.
    McSherry, E.: Disorders of acid-base equilibrium. Pediatr. Ann. 10: 302, 1981.PubMedGoogle Scholar
  17. 17.
    Prod-hom, L., Levison, H., Cherry, R. et al.: Adjustment of ventilation, intrapulmonary gas exchange and acid-base balance during the first day of life: infants with early respiratory distress. Pediatrics 35: 662, 1965.Google Scholar
  18. 18.
    Kildeberg, P.: Disturbances of hydrogen ion balance occurring in premature infants. II. Late metabolic acidosis. Acta Paediatr. Scand. 53: 517, 1964.CrossRefGoogle Scholar
  19. 19.
    Svenningsen, N.W. and Lindquist, B.: Incidence of metabolic acidosis in term, preterm and small-for-gestational-age infants in relation to dietary protein intake. Acta Paediatr. Scand. 62: 1, 1973.PubMedCrossRefGoogle Scholar
  20. 20.
    Schwartz, G.J., Haycock, G.B., Chir, B. et al.: Late metabolic acidosis: A reassessment of the definition. J. Pediatr. 95: 102, 1979.PubMedCrossRefGoogle Scholar
  21. 21.
    Svenningsen, N.W. and Lindquist, B.: Postnatal development of renal hydrogen ion excretion capacity in relation to age and protein intake. Acta Paediatr. Scand. 63: 721, 1974.PubMedCrossRefGoogle Scholar
  22. 22.
    Sulyok, E., Heim, T., Soltesz, G. and Jaszai, V.: The influence of maturity on renal control of acidosis in newborn infants. Biol. Neonate 21: 418, 1972.PubMedCrossRefGoogle Scholar
  23. 23.
    Kerpel-Fronius, E., Heim, T. and Sulyok, E.: The development of the renal acidifying processes and their relation to acidosis in low- birth-weight infants. Biol. Neonate 15: 156, 1970.PubMedCrossRefGoogle Scholar
  24. 24.
    Edelman, C.M.,Jr., Rodriguez-Soriano, J., Boichis, H. et al.: Renal bicarbonate reabsorption and hydrogen ion excretion in normal infants. J. Clin. Invest. 46: 1309, 1967.CrossRefGoogle Scholar
  25. 25.
    Svenningsen, N.W.: Renal acid-base titration studies in infants with and without metabolic acidosis in the post-neonatal period. Pediat. Res. 8: 659, 1974.PubMedGoogle Scholar
  26. 26.
    Sultan, S., Zilleruelo, G., Bancalari, E., et al.: Fractional bicarbonate excretion in low birth weight infants with metabolic acidosis. Pediatr. Res. l6: 329A, 1982.Google Scholar

Copyright information

© Martinus Nijhoff Publishers, Boston 1983

Authors and Affiliations

  • G. Zilleruelo
  • S. Sultan
  • E. Bancalari
  • B. Steele
  • J. Strauss

There are no affiliations available

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