Hypotension in neonates, particularly preterm, is a matter of debate in all its aspects (definition, monitoring and treatment).The neonate is uniquely at risk of hypotension and low systemic blood flow states due to failure or delay in the normal transition of circulatory processes.While managing the hypotensive neonate, it is not clear whether the issue to be addressed is low blood pressure or low flow states. With the development of newer technologies to assess this issue; the subject becomes more challenging and interesting.Most of the neonatal units use a stepwise approach for managing hypotension in neonates. Although the understanding of cellular mechanisms of action of inotropes is well founded, there is little information on their clinically relevant long-term benefits in the neonatal patient population. Also data regarding their safety and efficacy are lacking. The current clinical query tries to answer the issue of use of dopamine versus dobutamine as first line inotrope of choice in this group of neonates. This would hopefully help the clinician to apply the evidence based practice for management of hypotension in preterm neonate and would provide insight for future well designed studies.  

Keywords: Hypotension; Preterm; Dopamine; Dobutamine.