| Association between base excess levels and clinical outcomes among very low birth weight infants: a multicenter birth cohort study in South Korea |
Ji Yoo Kim1 
, Hyeon Jin Kim2,3
, Heeyoon Choi1
, Minji Kim2
, Jinseok Lee4
, Yong Sung Choi1
, Dong Keon Yon1,2
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1Department of Pediatrics, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Korea
2Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, Korea
3Department of Precision Medicine, Kyung Hee University, Seoul, Korea
4Department of Biomedical Engineering, Kyung Hee University, Yongin, Korea |
Correspondence:
Dong Keon Yon, Email: yonkkang@gmail.com
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Received: 28 November 2025 • Revised: 29 January 2026 • Accepted: 3 March 2026 |
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| Abstract |
Background
The impact of metabolic acidosis on short-term outcomes and mortality in very low birth weight infants (VLBWIs) has not been well studied.
Purpose
To investigate the potential association between metabolic acidosis and the clinical outcomes of VLBWIs in South Korea.
Methods
Between 2013 and 2019, data were collected from the Korean Neonatal Network, which covers a multicenter birth cohort spanning 75 hospitals. Our study cohort included 14,519 infants with a birth weight of less than 1,500 g who were admitted to the neonatal intensive care unit. Blood gas measurements taken within 1 hour of birth were used to evaluate the clinical outcomes, which were categorized into 5 groups according to base excess (BE) levels. We assessed respiratory outcomes, neurological morbidities, and infection-related and gastrointestinal outcomes along with mortality rates.
Results
We analyzed 10,394 VLBWIs based on the inclusion criteria. A BE level below -9 suggested a significantly high risk of various respiratory outcomes, including air leak syndrome (adjusted odds ratio [aOR], 2.071; 95% confidence interval [CI], 1.305–3.285), massive pulmonary hemorrhage (aOR, 2.317; 95% CI, 1.502–3.575), pulmonary hypertension (aOR, 2.296; 95% CI, 1.667–3.161), and neonatal respiratory distress syndrome (aOR, 2.219; 95% CI, 1.778–2.769). These infants also exhibited an elevated risk of neurological (aOR, 2.797; 95% CI, 2.314–3.380), infection-related (aOR, 2.082; 95% CI, 1.653–2.623), gastrointestinal (aOR, 1.979; 95% CI, 1.408–2.783), and mortality (aOR, 2.683; 95% CI, 2.076–3.466) outcomes.
Conclusion
Our findings highlight the potential effect of metabolic acidosis at birth on the clinical outcomes of VLBWIs. A strong correlation was observed between metabolic acidosis and neurological morbidity. These findings offer important insights for managing VLBWIs with metabolic acidosis and suggest the need |
| Key Words:
Base excess levels, Clinical outcomes, Metabolic acidosis, Very low birth weight infants |
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