A preterm infant with hypovolemic shock: should infants be examined twice or is once enough?

Shock in newborn and especially preterm infants carries significant risk of morbidity and mortality if not early recognized and adequately treated. Early signs of shock maybe missed and only identified in the late decompensated phase with lactic acidosis, cellular disruption and irreversible multiorgan damage. In neonates, the etio-pathologic origin of shock is unique particularly in extreme preterm infants with complicated postnatal transition phase, immature myocardium, and high peripheral systemic resistance. Hypovolemic shock shortly after birth is uncommon and may complicates fetomaternal or fetoplacental transfusion, abruptio placenta, intracranial hemorrhage, or capillary leak syndrome. In the absence of obvious history of blood loss, a careful second clinical assessment maybe warranted to recognize the underlying etiology and institute a targeted intervention.