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



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.


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.


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

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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.

Ethical approval

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).

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