Inotropic Score and Vasoactive Inotropic Score as Predictors of Outcomes in Congenital Diaphragmatic Hernia: A Single Center Retrospective Study

Authors

Srirupa Hari Gopal
Cynthia L Toy
Morcos Hanna
Betul Yilmaz Furtun
Joseph L Hagan
Ahmed A Nassr
Caraciolo J Fernandes
Sundeep Keswani
Sharada H Gowda

Publication Date

1-1-2023

Journal

Frontiers in Pediatrics

DOI

10.3389/fped.2023.1101546

PMID

36816370

PMCID

PMC9929143

PubMedCentral® Posted Date

2-1-2023

PubMedCentral® Full Text Version

Post-print

Published Open-Access

yes

Keywords

congenital diaphragmatic hernia, pulmonary hypertension, ventricular dysfunction, inotropic score, vasoactive inotropic score, extracorporeal membrane oxygenation

Abstract

BACKGROUND: Neonates with congenital diaphragmatic hernia (CDH) have varying degrees of pulmonary hypoplasia, pulmonary hypertension (PH) and cardiac dysfunction. These neonates frequently require vasoactive support and are at high risk for mortality and morbidity, including prolonged ventilator support, need for extracorporeal membrane oxygenation (ECMO), prolonged length of stay, and need for tracheostomy. However, identifying which infants are at increased risk can be challenging. In this study, we sought to investigate the utility of the inotropic score (IS) and vasoactive inotropic score (VIS) as tools to predict significant clinical outcomes and overall survival in patients with CDH. Additionally, we evaluated the correlation between IS/VIS and postnatal echocardiographic variables.

METHODS: This was a retrospective chart review of 57 patients with CDH whose postnatal care was based on a standardized institutional protocol. We calculated the IS/VIS at 6-, 12-, 24-, 48 hours of life (HOL), on the day of CDH repair and 24- and 48 hours after surgical repair. The association of these scores with postnatal echocardiographic markers was analyzed using Pearson's correlation and linear regression, while logistic regression was used for binary outcomes, and Cox proportional hazards regression was used to assess associations with survival.

RESULTS: We found that every one-unit increase in IS/VIS at 6 HOL was associated with 13% increase in the odds of ECMO (

CONCLUSION: This retrospective study showed a significant association between IS/VIS obtained at various time points with clinical outcomes and echocardiographic findings in CDH, which could be used to guide prognosis and management in this patient population.