Regarding treatment of neonatal shock, which statement is true?

• A. Albumin is more effective than normal saline in increasing blood pressure
• B. Fluid resuscitation should be minimized in the treatment of shock
• C. Administration of large volumes of normal saline may improve acidosis
• D. Isotonic saline has been shown to be harmful in increasing blood pressure

Answer: (B)

In neonatal shock, careful, not excessive, fluid management is crucial. Neonates often have fragile perfusion with potential cardiogenic or capillary leak components, so large-volume fluid boluses can worsen edema, respiratory status, or cardiac function. The practical approach is to give small, guided isotonic fluid boluses (for example, 10–20 mL/kg) with rapid reassessment, and promptly move to vasoactive support if perfusion does not improve. This minimizes the risk of fluid overload while restoring enough circulating volume to support perfusion.

Albumin has not been shown to be superior to normal saline for increasing blood pressure in neonatal shock, so relying on albumin for this purpose isn’t the preferred strategy. Large volumes of normal saline do not reliably correct acidosis and can worsen hyperchloremic acidosis, making that approach less favorable. Isotonic saline itself is not inherently harmful to blood pressure when used judiciously, but excessive volumes are not the goal.