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

Journal of Perinatology volume 41, pages 2337–2344 (2021)Cite this article

Subjects

Abstract

Objective

To determine the relationship between maximum vasoactive-inotropic (VISmax) 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 VISmax of 0, the frequency of mortality based on VISmax ranged from 3.3-fold to 46.1-fold. VISmax > 30 was associated with universal mortality. Multivariable modeling that included gestational age, birth weight, and VISmax 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

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

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Fig. 1: Vasoactive-inotropic medication exposure and VISmax by gestational age and birth weight.
Fig. 2: Mortality by VISmax range.
Fig. 3: Modeling mortality risk using VISmax among those that received vasoactive-inotropic medications.

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Funding

This work was not directly supported. JLW receives support from the National Institutes of Health (NIH; R01GM128452; R01HD089939, R01HD097081, R43EB029863).

Author information

Author notes

  1. These authors contributed equally: Khyzer B. Aziz, Orlyn C. Lavilla

  2. These authors jointly supervised this work: James L. Wynn, Diomel de la Cruz

Authors and Affiliations

  1. Department of Pediatrics, Johns Hopkins University, Baltimore, MD, USA

    Khyzer B. Aziz

  2. Department of Pediatrics, University of Florida, Gainesville, FL, USA

    Orlyn C. Lavilla, James L. Wynn, Allison C. Lure, Daniel Gipson & Diomel de la Cruz

  3. Department of Pathology, Immunology, and Laboratory Medicine, University of Florida, Gainesville, FL, USA

    James L. Wynn

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Contributions

IRB or collected primary data (AL, OL, DG, DC, and JW); performed the analysis (JW); wrote first draft (KA, OL, JW, and DC); edited draft (all authors); concept and content (KA, JW, and DC).

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Correspondence to James L. Wynn or Diomel de la Cruz.

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The authors declare no competing interests.

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This study was approved by the Institutional Review Board at the University Of Florida (IRB201902780). The study was performed in accordance with the Declaration of Helsinki.

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Aziz, K.B., Lavilla, O.C., Wynn, J.L. et al. Maximum vasoactive-inotropic score and mortality in extremely premature, extremely low birth weight infants. J Perinatol 41, 2337–2344 (2021). https://doi.org/10.1038/s41372-021-01030-9

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