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I've used roughly the same thresholds as Hamed, fudging a little higher or lower based on symptoms.  In addition to the collateral information Hamed recommended, the single biggest thing to figure out (in my experience) is whether this is iatrogenic or not.  Often times, iatrogenic hypercalcemia even at high levels, can self-correct whereas if there is a real underlying cause, that too can suggest definitive therapy.  Assuming it is not iatrogenic and the Family history is non-contributory, I would at least consider a diagnosis of William's Syndrome.

I practice in two very different ICU environments, one delivery and one which is more of a med-surg ICU closer to a PICU than a NICU in many ways.  I think the data are clear and many of the previous respondents concur that NaHCO3 in the delivery setting is at best useless.  For the ELBW with anticipated renal losses NaHCO3 should almost never be needed because these losses can be anticipated and should be incorporated into nutrition to avoid the biochemical inevitabilities noted in the articles Stefan cited.  I suppose I might use bicarb in the preemie population if I had metabolic acidosis and evidence it was effecting cardiac output and even then I probably would not correct past 7.2. However, in the case of the older child or the med-surg patient where some specific pathologic perturbation has led to rapid collapse and I suspect part of that mechanism is bicarb deficit, I would have no hesitation to rapid correct the pH.  I have several times done this and watched the EKG improve in real time.

When I was a fellow, I trained at a delivery hospital that used flow-inflating bags and it made this sort of failure very easy to recognize (if there was any defect in flow, the bag would not inflate).  The downside to this is that without flow you can't give ANY respiratory support (after a critical incident of this kind where the flow inflating bag actually ripped in the middle of a resuscitation, we started stocking an emergency ambulance bag as back-up).

Thanks. It's very nice and necesary

Having read this article has many good ideas in my experience. The design rethink many good idea . 👌 for the safety of the neonates. I'd like to highlight 2 features. 1) ambulance tv screen/camera  allows connexion the hospital site, such as when a tertiary center is necessary. Here a neonatologist can lead the team to provide optimum care of the neonate on transfer. It can use for example the zoom© software enabling remote telehealth service. Alternatively , the ambulance designed by the generalitat de catalunia  is powered 4G-5G comm .Its communication system is has a direct to the hospital site , where a clinical is there to provide supportany time. 2), I feel solar roof can provide some autonomy on transport. It also a sustainable option , make it a bit more green.