The aim of this study was to assess if albumin infusion in hypotensive, preterm infants improved blood pressure (BP), metabolic acidosis and core peripheral temperature difference, indicating that such infants had been hypovolemic. Thirty-seven infants, median gestational age 27 weeks (range 23-34) were studied. Their mean BP, core-peripheral temperature difference, pH and base deficit prior to and post albumin infusion were compared. Albumin infusion was associated with BP elevation (p < 0.01) and a small reduction in the base deficit (p < 0.01), but no significant changes overall in the pH or peripheral core temperature difference. Similar results were seen if only 34 infants less than or equal to 4 days of age treated for their first episode of hypotension were considered, although in that group there was also a modest rise in pH (p < 0.02). These data suggest clinically relevant hypovolemia is uncommon in hypotensive, preterm ventilated infants and hence volume expanders are inappropriate routine first therapy.