Validity of the vasoactive-inotropic score in preterm neonates receiving cardioactive therapies

Ashraf Kharrat; Gabriella Ripstein; Michelle Baczynski; Faith Zhu; Xiang Y Ye; Sebastien Joye; Amish Jain

doi:10.1016/j.earlhumdev.2022.105657

Validity of the vasoactive-inotropic score in preterm neonates receiving cardioactive therapies

Early Hum Dev. 2022 Oct:173:105657. doi: 10.1016/j.earlhumdev.2022.105657. Epub 2022 Aug 20.

Authors

Ashraf Kharrat¹, Gabriella Ripstein², Michelle Baczynski³, Faith Zhu⁴, Xiang Y Ye⁵, Sebastien Joye⁶, Amish Jain⁷

Affiliations

¹ Department of Paediatrics, Mount Sinai Hospital, Toronto, ON, Canada; Department of Paediatrics, University of Toronto, Toronto, ON, Canada. Electronic address: ashraf.kharrat@sinaihealth.ca.
² Queen's University, Kingston, ON, Canada.
³ Department of Respiratory Therapy, Mount Sinai Hospital, Toronto, ON, Canada.
⁴ Department of Paediatrics, University of Toronto, Toronto, ON, Canada.
⁵ Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, ON, Canada.
⁶ Clinic of Neonatology, Lausanne University Hospital, Lausanne, Switzerland.
⁷ Department of Paediatrics, Mount Sinai Hospital, Toronto, ON, Canada; Department of Paediatrics, University of Toronto, Toronto, ON, Canada; Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada.

PMID: 36087459
DOI: 10.1016/j.earlhumdev.2022.105657

Abstract

Background: Vasoactive-Inotropic Score (VIS) is a weighted sum of various vasopressors and inotropes; its utility among preterm neonates is understudied.

Objective: To investigate the association between maximum VIS (VIS^max) during the first 12, 24 and 48 h of treatment among preterm neonates who received vasopressors/inotropes, and the composite outcome of death/severe neuroinjury (sNI).

Methods: Retrospective cohort study, over 6-years, including neonates <35 weeks gestational age (GA). Infants who met the primary composite outcome of death or sNI (defined as new intraventricular hemorrhage ≥grade 3 or periventricular leukomalacia) were compared to those who survived without sNI. Maximum VIS was categorized as <10, 10-19 or ≥ 20 for comparison.

Results: 192 infants (mean GA and birth weight 26.8 ± 3.3 weeks and 952 ± 528 g, respectively) were included. The most common primary diagnosis was sepsis/necrotizing enterocolitis (69 %). Median VIS for the entire cohort was 10. Death/sNI was associated with lower GA at birth and treatment, as well as higher frequency of VIS^max of 10-19 or ≥20, compared to <10, during each time period (all p < 0.01). Multivariable regression revealed GA at treatment and VIS^max ≥ 20 [not 10-19, referenced to <10] were associated death/sNI; adjusted odds ratio (95 % CI) for VIS^max ≥ 20 within 12, 24, and 48 h were 4.2 (1.6-11.0), 4.9 (1.9-12.3), and 6.7 (2.7-16.7), respectively.

Conclusions: Vasoactive-Inotropic Score may be a valid measure to quantify cardiovascular support in preterm infants needing hemodynamic support. Maximum VIS ≥20 within 48 h of treatment initiation may identify patients at high risk of adverse outcomes.

Keywords: Inotropes; Neonate; Outcomes; Vasoactive.

MeSH terms

Enterocolitis, Necrotizing*
Gestational Age
Humans
Infant
Infant, Newborn
Infant, Newborn, Diseases*
Infant, Premature
Retrospective Studies