Clinical and echocardiographic response to volume expansion in hypotensive preterm infants

Objective : Hemodynamic instability is common in preterm neonates. Volume expansion remains controversial due to its uncertain efficacy and potential adverse effects. The objective was to evaluate the effects of volume expansion in preterm infants with hypotension within 24 hours of birth. Study Design : Retrospective study of preterm neonates receiving modified fluid gelatin for hypotension. Clinical and echocardiographic parameters were compared before and after treatment. Results : In 31 infants, volume expansion significantly increased systolic, diastolic, and mean arterial pressures (mean increase: +6, +3, +4 mmHg respectively; p < 0.0001), and decreased heart rate (−10 bpm) and capillary refill time (−0.5 s; p < 0.0001). Improved echocardiographic markers of preload and output included Left Ventricular End-Diastolic Diameter (+1.3 mm), Superior Vena Cava flow (+16.2 ml/kg/min), and ductus arteriosus shunt velocity (+0.21 m/s). No adverse effects were reported. Conclusion : Volume expansion improved clinical and echocardiographic parameters in hypotensive preterm infants without observed complications.