Scenario

An infant at 38 weeks was delivered 1 h ago and did not require any resuscitation at delivery. There is no history of placental abruption or fetomaternal haemorrhage. Her cord gas pH was 7.3. She is vigorous but pale with a delayed capillary refill time (>3 s) and the resident has admitted her to the nursery. A venous blood gas is done, which reveals a normal haemoglobin value and a metabolic acidosis (pH 7.2 and a base excess of −11) with an elevated lactate (6 mmol/L). The neonatologist on duty requests a fluid bolus is given to ‘treat the acidosis’. You wonder as to the value of this seemingly routine invention in your nursery.

Structured clinical question

In a late preterm or term infant with signs of haemodynamic compromise with diverse underlying clinical conditions (excluding acute haemorrhage) [patient] does an initial fluid bolus (10 mL/kg) [intervention] compared with no fluid bolus [comparison] provide any objective clinical benefit? [outcome].

Haemodynamic compromise was defined as hypotension, lactic acidosis, other metabolic acidosis, poor perfusion as assessed clinically, abnormal gas exchange or combinations …