# Neonatal Hypovolemic Cardiac Arrest: Role of Early Rapid Volume Resuscitation

> **NIH NIH R03** · UNIVERSITY OF CALIFORNIA AT DAVIS · 2023 · $160,000

## Abstract

PROJECT SUMMARY/ ABSTRACT
 Birth asphyxia is a common cause of perinatal mortality. In some infants, loss of fetal blood
volume contributes to asphyxia. The role of volume replacement in newborns affected by fetal
blood loss (e.g., fetal-maternal hemorrhage), resulting in hypovolemia and hypoxia is poorly
understood. For severe bradycardia or cardiac arrest associated with fetal blood loss, the current
standard neonatal resuscitation guidelines recommend intravenous epinephrine with subsequent
use of volume expanders (normal saline or red blood cells) administered slowly over 5 to 10
minutes. Such volume replacement is reserved for newborns not responding to ventilation, chest
compressions, and epinephrine. This approach may not be effective to result in return of
spontaneous circulation due to lack of adequate preload to the heart following acute blood loss.
Early rapid volume replacement over 2 minutes may potentially increase the incidence of and
hasten the return of spontaneous circulation. Emergent situation, inability to predict birth asphyxia
and ethical concerns preclude performance of prospective clinical studies comparing early, rapid
volume replacement and delayed slower volume replacement in human neonates. The 2020
Neonatal Life Support Task force in International Liaison Committee on Resuscitation (ILCOR)
has identified volume replacement as a knowledge gap for neonatal providers. The current
recommendations are based on expert opinion that the benefits outweigh the risks.
 We propose to perform a randomized trial comparing early rapid saline bolus during
neonatal resuscitation, standard neonatal resuscitation (with slower volume replacement) and no
volume replacement (placebo) in a perinatal term ovine model of hypovolemic asphyxial cardiac
arrest. We hypothesize that early and rapid volume replacement during neonatal resuscitation will
increase the incidence of return of spontaneous circulation in hypovolemic asphyxial cardiac
arrest.

## Key facts

- **NIH application ID:** 10739265
- **Project number:** 1R03HD109443-01A1
- **Recipient organization:** UNIVERSITY OF CALIFORNIA AT DAVIS
- **Principal Investigator:** Deepika Sankaran
- **Activity code:** R03 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2023
- **Award amount:** $160,000
- **Award type:** 1
- **Project period:** 2023-08-01 → 2025-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10739265

## Citation

> US National Institutes of Health, RePORTER application 10739265, Neonatal Hypovolemic Cardiac Arrest: Role of Early Rapid Volume Resuscitation (1R03HD109443-01A1). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10739265. Licensed CC0.

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