The fluid shift from the vascular compartment immediately after birth.

'It was suggested that the shift might take place particularly from the pulmonary circulation and so contribute to the development of pulmonary oedema and respiratory failure . . ..' Today. What to do, if anything, about the changes in haemoglobin, packed cell volume, plasma, and whole blood volume in the first day or two of life has exercised the minds of paediatricians for at least 30 years. These early observations have stood the test of time and it is now generally accepted that transfusion of extra blood from the placenta, once actively encouraged, can be harmful. It initially renders the baby hypervolaemic, encourages dilatation of the capillary bed with further transudate, which causes increased oedema and intravascular polycythaemia. It is also accepted that transudation from the pulmonary capillary is a precursor of hyaline membrane formation so retention of plasma within the vascular space would seem a sensible objective. The fact that an early diuresis signals a good prognosis in preterm infants with respiratory distress probably indicates return of this oedema fluid into the intravascular space with the associated improved haemodynamics similar to that seen after haemodilution, the therapeutic equivalent in infants with hyperviscosity. I have always felt that the advantages of improved oncotic pressure (albeit transient) from infusions of albumin with the consequent reduction of tissue oedema and improved renal output outway any disadvantage there might be in increasing blood volume and so possibly prolonging patency of the ductus arteriosus. The fact that oedema does not correlate well with serum albumin is not the point.' Whether the baby benefits from its administration surely is and recent work would encourage the practice of infusion of salt free albumin.2