Department of Paediatrics, Mount Sinai Hospital, Toronto, ON, Canada; Department of Paediatrics, University of Toronto, Toronto, ON, Canada.
Queen's University, Kingston, ON, Canada.
Early Hum Dev. 2022 Oct;173:105657. doi: 10.1016/j.earlhumdev.2022.105657. Epub 2022 Aug 20.
Vasoactive-Inotropic Score (VIS) is a weighted sum of various vasopressors and inotropes; its utility among preterm neonates is understudied.
To investigate the association between maximum VIS (VIS) 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).
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.
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 of 10-19 or ≥20, compared to <10, during each time period (all p < 0.01). Multivariable regression revealed GA at treatment and VIS ≥ 20 [not 10-19, referenced to <10] were associated death/sNI; adjusted odds ratio (95 % CI) for VIS ≥ 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.
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.
血管活性-正性肌力评分（VIS）是各种血管加压药和正性肌力药的加权总和；其在早产儿中的应用研究还很有限。
研究接受血管加压药/正性肌力药治疗的早产儿在治疗的前 12、24 和 48 小时内最大 VIS（VIS）与死亡/严重神经损伤（sNI）复合结局之间的关系。
这是一项回顾性队列研究，时间跨度为 6 年，纳入胎龄＜35 周的新生儿。将符合死亡或 sNI 主要复合结局（定义为新出现的脑室出血≥3 级或脑室周围白质软化）的婴儿与无 sNI 存活的婴儿进行比较。最大 VIS 分为＜10、10-19 或≥20 进行比较。
共纳入 192 名婴儿（平均胎龄和出生体重分别为 26.8±3.3 周和 952±528g）。最常见的主要诊断是败血症/坏死性小肠结肠炎（69%）。整个队列的中位 VIS 为 10。死亡/sNI 与出生时胎龄较低和治疗有关，与 VIS＜10 相比，每个时间点的 VIS 为 10-19 或≥20 的频率更高（均 p＜0.01）。多变量回归显示治疗时的胎龄和 VIS≥20（而非 10-19，与＜10 相比）与死亡/sNI 相关；VIS≥20 在 12、24 和 48 小时内的调整比值比（95%CI）分别为 4.2（1.6-11.0）、4.9（1.9-12.3）和 6.7（2.7-16.7）。
血管活性-正性肌力评分（VIS）可能是一种有效衡量需要血流动力学支持的早产儿心血管支持的指标。治疗开始后 48 小时内最大 VIS≥20 可能识别出有不良结局高风险的患者。
