DOI: https://doi.org/10.36347/sjams.2025.v13i05.015

Pages: 1094-1100

Background: Metabolic acidosis is a frequent condition among neonates in the Neonatal Intensive Care Unit (NICU), often reflecting disorders such as sepsis, perinatal asphyxia, or respiratory failure. The corrected anion gap (cAG), which adjusts for serum albumin, may offer better prognostic value than traditional acid-base parameters. Limited data exist on its predictive role in neonatal outcomes. This study aims to evaluate the corrected anion gap (cAG) role in predicting in-hospital mortality and mechanical ventilation requirements among NICU neonates with metabolic acidosis. Methods: This prospective observational study was conducted at the NICU of Bangladesh Shishu Hospital & Institute, Dhaka, from July 2021 to June 2023. A total of 115 neonates with metabolic acidosis were included. Participants were divided into survival (n=64) and non-survival (n=51) groups based on in-hospital outcomes. Data on acid-base variables, clinical conditions, and outcomes were collected. Statistical analyses included t-tests, logistic regression, and Pearson’s correlation, using SPSS version 25.0. Results: Mean cAG was significantly higher in non-survivors (31.53±7.01) than survivors (18.60±8.74) (p<0.001). cAG positively correlated with mechanical ventilation need (r=0.607, p=0.001) and negatively with NICU length of stay (r=−0.213, p=0.023). Multivariate logistic regression identified cAG as an independent predictor of mortality (OR: 1.321; 95% CI: 1.140–1.532; p<0.001), along with respiratory failure and elevated serum creatinine. Conclusion: Corrected anion gap is a reliable and independent marker for predicting mortality and mechanical ventilation in critically ill neonates and should be integrated into early NICU assessment protocols.