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At the age of 4 hours, a tachypnoeic, well hydrated, well perfused, and normotensive 34 week preterm neonate develops a metabolic acidosis (arterial pH 7.25, base deficit minus 10 mmol/l). There was no history of perinatal blood loss or sepsis risk factors. No resuscitation was required at birth, and the cord blood pH was 7.3. According to departmental protocol, volume expansion with an intravenous bolus of 10–20 ml/kg of normal saline or 4.5% albumin is advised. You wonder as to the value of this volume expansion.
Structured clinical question
In the absence of asphyxia or hypovolaemia in a newborn infant with metabolic acidosis [patient] does an intravenous bolus of normal saline or albumin [intervention] improve the following [outcomes]: pH, base deficit, mortality, morbidity, length of hospital stay, neurodevelopmental disability? …
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