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

Objective: To determine the relationship between maximum vasoactive-inotropic (VIS) 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 of 0, the frequency of mortality based on VIS ranged from 3.3-fold to 46.1-fold. VIS > 30 was associated with universal mortality. Multivariable modeling that included gestational age, birth weight, and VIS 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 is an objective measure of hemodynamic/cardiovascular support that was directly associated with mortality in extremely premature ELBW infants. The VIS represents an important step towards neonatal precision medicine and risk stratification of extremely premature ELBW infants.