In a premature newborn resuscitation with pH 7.20, PaCO2 39, PaO2 65, and HCO3- 16, which action is recommended?

• A. hyperventilation
• B. suction and check the airway
• C. administer sodium bicarbonate
• D. echocardiogram

Answer: (C)

The situation shows a metabolic acidosis pattern: acidemia with a low bicarbonate and a normal to near-normal PaCO2. This means the primary disturbance is metabolic rather than respiratory. In a premature newborn with significant metabolic acidosis, buffering with sodium bicarbonate can transiently raise the pH and improve perfusion and myocardial function, helping the infant respond to ongoing resuscitation. It directly addresses the hydrogen-ion overload indicated by the low bicarbonate. You’d want to ensure there’s adequate ventilation to handle CO2 produced by buffering, but the key step here is to correct the metabolic deficit rather than alter ventilation or pursue non-relevant tests. Hyperventilation would not fix the metabolic cause, suctioning/airway check, while important, does not treat the acid-base abnormality, and an echocardiogram isn’t an immediate resuscitation priority in this context unless there are signs of a cardiac issue.