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This study was designed to assess the comparative efficacy of normal saline (NS) and 5% albumin (ALB) for treatment of hypotension in the acutely ill newborn.Newborn infants who were24 hours old and were admitted to the Holden Neonatal Intensive Care Unit at the University of Michigan were randomized to receive one of the two solutions for volume expansion. Hypotension was defined as a sustained (or =30 minutes) mean arterial pressure (MAP) of30 mmHg for infants weighingor =2500 g, or a MAP of40 mmHg for those weighing2500 g. The short-term outcome measure was the resolution of hypotension defined as a MAP over the minimum limits set for birthweight sustained foror =30 minutes.In total 41 infants met criteria and were entered. Of these, 21 infants received ALB and 20 received NS. Successful treatment was seen in 17/21 (81%) of infants in the ALB group and 17/20 (85%) of infants in the NS group. There was no statistically significant difference in response to treatment (p=0.30). In addition, there was no statistically significant difference in the magnitude of change in MAP between the two (p=0.41).NS was shown to be as effective as ALB for the correction of acute hypotension in the newborn infant. Given comparable efficacy of NS, along with its relatively low cost and availability, it should be considered the initial treatment of choice in this setting.

70 patients admitted to the University of Michigan Holden NICU from 21/1/93 through 11/15/96 received inhaled nitric oxide (NO) therapy. 62/70 patients were diagnosed with persistent pulmonary hypertension of the newborn (PPHN) as documented by echocardiogram and/or pre- and postductal PaO2 gradients. 8/70 patients were treated for persistent, intractable hypoxemia thought secondary to intrapulmonary shunt. A positive response was defined as an increase in postductal PaO2 to avoid ECMO. Permanent responders (28/70; 40%) were those who sustained a significant enough increase in postductal PaO2 to avoid ECMO. Transient responders (15/70; 21%) were those who had an initial positive response to inhaled NO, but could not sustain an adequate postductal PaO2, and required ECMO. Non-responders (27/70; 39%) were those who did not respond with an adequate increase in postductal PaO2 to an initial NO test of 40-80 ppm. Non-responders had a mean (+/- SD) baseline PaO2 of 45.6 (+/- 15.3) Torr. Mean baseline PaO2 in transient responders (38.6 +/- 14 Torr) was not significantly different from non-responders (P