Shock and Hypotension in the Newborn Differential Diagnoses

  • Author: Samir Gupta, DM, MRCP, MD, FRCPCH, FRCPI; Chief Editor: Ted Rosenkrantz, MD  more...
Updated: Mar 27, 2014

Diagnostic Considerations

Conditions to consider in the differential diagnosis of shock and hypotension in the newborn include the following:

  • Coarctation of the aorta
  • Congenital adrenal hyperplasia
  • Consumption coagulopathy
  • Dehydration
  • Enteroviral infections
  • Escherichia coli infections
  • Hemorrhagic disease of newborn
  • Viral myocarditis
  • Necrotizing enterocolitis
  • Neonatal sepsis
  • Oliguria
  • Outflow obstructions
  • Periventricular hemorrhage–intraventricular hemorrhage

Differential Diagnoses

Contributor Information and Disclosures

Samir Gupta, DM, MRCP, MD, FRCPCH, FRCPI Professor of Neonatal Medicine, Deputy Director, Research and Development, University of Durham and North Tees University Hospital, UK

Samir Gupta, DM, MRCP, MD, FRCPCH, FRCPI is a member of the following medical societies: British Medical Association, Society for Pediatric Research, European Society for Paediatric Research, Royal College of Paediatrics and Child Health, European Respiratory Society, Royal College of Physicians of Ireland

Disclosure: Nothing to disclose.


Sunil K Sinha, MBBS, MD, MRCP, PhD, FRCP, FRCPCH Director of Neonatal Services, South Cleveland Hospital, UK

Sunil K Sinha, MBBS, MD, MRCP, PhD, FRCP, FRCPCH is a member of the following medical societies: British Medical Association, Royal College of Physicians

Disclosure: Nothing to disclose.

Chief Editor

Ted Rosenkrantz, MD Professor, Departments of Pediatrics and Obstetrics/Gynecology, Division of Neonatal-Perinatal Medicine, University of Connecticut School of Medicine

Ted Rosenkrantz, MD is a member of the following medical societies: American Academy of Pediatrics, American Pediatric Society, Eastern Society for Pediatric Research, American Medical Association, Connecticut State Medical Society, Society for Pediatric Research

Disclosure: Nothing to disclose.


David A Clark, MD Chairman, Professor, Department of Pediatrics, Albany Medical College

David A Clark, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Pediatric Society, Christian Medical & Dental Society, Medical Society of the State of New York, New York Academy of Sciences, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Pharmacy Editor, eMedicine

Disclosure: Nothing to disclose.

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Determinants of cardiac function and oxygen delivery to tissues. Adapted from Strange GR. APLS: The Pediatric Emergency Medicine Course. 3rd ed. Elk Grove Village, Ill: American Academy of Pediatrics; 1998:34.
Assisted ventilation newborn –Intubation and meconium aspiration. Video courtesy of Therese Canares, MD, and Jonathan Valente, MD, Rhode Island Hospital, Brown University.
Table 1. Agents Used To Treat Neonatal Shock
Agent TypeAgentInitial DosageAdditional Factors
Volume expandersIsotonic sodium chloride solution10-20 mL/kg intravenous (IV)Inexpensive, available
Albumin (5%)10-20 mL/kg IVExpensive
Plasma10-20 mL/kg IVExpensive
Lactated ringer solution10-20 mL/kg IVInexpensive, available
Isotonic glucose10-20 mL/kg IVInexpensive, available
Whole blood products10-20 mL/kg IVLimited availability
Reconstituted blood products10-20 mL/kg IVUse type

O negative

Vasoactive drugsDopamine5-20 mcg/kg/min IVNever administer intra-arterially
Dobutamine5-20 mcg/kg/min IVNever administer intra-arterially
Epinephrine0.05-1 mcg/kg/min IVNever administer intra-arterially
Hydralazine0.1-0.5 mg/kg IV every 3-6 hAfterload reducer
Isoproterenol0.05-0.5 mcg/kg/min IVNever administer intra-arterially
Nitroprusside0.5-8 mcg/kg/min IVAfterload reducer
Norepinephrine0.05-1 mcg/kg/min IVNever administer intra-arterially
Phentolamine1-20 mcg/kg/min IVAfterload reducer
Milrinone22.5-45 mcg/kg/h continuous IV infusion (ie, 0.375-0.75 mcg/kg/min)Afterload reducer in cardiac dysfunction; decrease dose with renal impairment
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