Use of sodium bicarbonate in newborn resuscitation should be reserved for which context?

• A. During active resuscitation
• B. Post-resuscitation care in NICU guided by arterial blood gas levels or serum chemistries
• C. Only if heart rate fails to rise after 60 seconds
• D. Never used under any circumstance

Answer: (B)

The main idea is that sodium bicarbonate is not part of the resuscitation sequence itself. During newborn resuscitation, the priority is to restore ventilation and circulation with appropriate chest compressions and support. Giving bicarbonate during active resuscitation does not improve outcomes and can actually worsen the situation by increasing CO2 production and shifting the acid–base balance in a way that worsens intracellular acidosis, especially when perfusion and oxygen delivery are still compromised.

Sodium bicarbonate may be considered later, in the post-resuscitation period, only if arterial blood gas and serum chemistries show persistent metabolic acidosis after stabilization. In that context, its use is guided by lab values and clinical status, with careful monitoring, to correct severe metabolic acidosis rather than to influence the immediate resuscitation effort. This approach avoids masking ongoing hypoxia or poor perfusion and targets the underlying metabolic derangements once the infant’s ventilation and circulation are being adequately managed.