Sodium bicarbonate use in neonatal resuscitation should be reserved for post-resuscitation care and guided by which of the following?

• A. Arterial blood gas levels or serum chemistries
• B. Pulse oximetry targets
• C. Heart rate trajectory
• D. Capillary refill time

Answer: (A)

Sodium bicarbonate is used to correct metabolic derangements, not as a routine resuscitation intervention. After return of spontaneous circulation, decisions about bicarbonate should be based on objective lab data that show the newborn’s acid-base and electrolyte status. Arterial blood gas levels and serum chemistries provide a direct snapshot of pH, bicarbonate, base deficit, lactate, and electrolytes, which tells you whether metabolic acidosis persists and whether bicarbonate is needed and how much.

Other monitoring methods during resuscitation serve different purposes. Pulse oximetry targets guide oxygenation, heart rate trajectory reflects resuscitation progress, and capillary refill time assesses perfusion—none of these directly quantify acid-base balance or electrolyte status to determine bicarbonate therapy.