Volume expansion must therefore be carefully undertaken with careful and continual monitoring of the circulatory status. Dopamine or other pressor agents may have a role in normalizing blood pressure and renal blood flow. Once adequate oxygenation is established, administration of sodium bicarbonate may be indicated with a severe, persistent metabolic acidosis. Rapid infusion of bicarbonate should be avoided to prevent increases in serum osmolality and the adverse effects of alkalinization on cerebral blood flow. In the normal state, it is important that the brain receive a continous supply of both oxygen and glucose, the two primary sources of energy for neurons and glia.
Fluid overload is a distinct but avoidable hazard in the treatment of asphyxiated infant.
Careful fluid and electrolyte monitoring can detect the presence of either of these conditions. Seizures, when present, should be recognized and treated vigorously. This is important because cerebral oxygen use is increased almost fivefold during a seizure. The use of steroids in cytotoxic edema initially had some appeal, but currently there is no proof of its effectiveness. In vasogenic edema characterized by breakdown of the brain capillary with disruption of the blood brain barrier, steroids have been thought to be effective, although this has not been proven by controlled studies.