If an emergency volume expander is indicated during neonatal resuscitation, the initial dose is:

• A. 5 ml/kg
• B. 10 ml/kg
• C. 15 ml/kg
• D. 20 ml/kg

Answer: (B)

When a volume expander is needed during neonatal resuscitation, the aim is to quickly increase preload to improve cardiac output in a hypovolemic infant. The best initial bolus is 10 ml/kg of isotonic crystalloid (such as normal saline or lactated Ringer’s). This dose reliably expands the intravascular space without overloading the heart. Smaller amounts, like 5 ml/kg, may not produce enough hemodynamic effect, while larger initial doses (15–20 ml/kg) are usually reserved for subsequent boluses if perfusion remains poor. If there’s still inadequate response after the first bolus, a second 10 ml/kg can be given for a total of up to about 20 ml/kg to renal, perfusion, and oxygenation status, always monitoring for signs of fluid overload. Use isotonic fluids and avoid dextrose-containing solutions during resuscitation.