Maximum Vasoactive-Inotropic Score and Mortality in Extremely Premature, Extremely Low Birth Weight Infants

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 grams) infants. STUDY DESIGN: Single-center, retrospective, 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.