Maximum vasoactive-inotropic score and mortality in extremely premature, extremely low birth weight infants

Abstract

Objective: To determine the relationship between maximum vasoactive-inotropic (VIS^max) and mortality in extremely premature (<29 weeks completed gestation), extremely low birth weight (ELBW, <1000 g) infants.

Study design: Single center, retrospective, and observational cohort study.

Results: We identified 436 ELBW, <29 week, inborn infants cared for during the study period. Compared to infants with VIS^max of 0, the frequency of mortality based on VIS^max ranged from 3.3-fold to 46.1-fold. VIS^max > 30 was associated with universal mortality. Multivariable modeling that included gestational age, birth weight, and VIS^max revealed significant utility to predict mortality with negative predictive value of 87.0% and positive predictive value of 84.8% [adjusted AUROC: 0.90, (0.86-0.94)] among patients that received vasoactive-inotropic treatment.

Conclusion: VIS^max is an objective measure of hemodynamic/cardiovascular support that was directly associated with mortality in extremely premature ELBW infants. The VIS^max represents an important step towards neonatal precision medicine and risk stratification of extremely premature ELBW infants.