Validation of the vasoactive-ventilation-renal score in extreme preterm neonates

Objectives To validate Vasoactive-Ventilation-Renal (VVR) score in extremely low gestational age neonates (ELGANs) as a predictor of mortality and morbidity by assessing its association with clinical outcomes. Study Design This was a secondary analysis of data from a randomized controlled trial including neonates born 23 0 –28 6 weeks’ gestation admitted to a Canadian tertiary-level neonatal intensive care unit between February 2019 and December 2021. VVR scores were measured at set intervals. Outcomes included mortality, intraventricular hemorrhage (IVH), bronchopulmonary dysplasia (BPD), necrotizing enterocolitis, patent ductus arteriosus, retinopathy of prematurity, mechanical ventilation duration, and length of hospital stay. Multivariate logistic regression analysis and receiver operating characteristic (ROC) curves were used to determine the association between VVR scores and clinical outcomes. Results Data from 132 neonates were analyzed. The mean (SD) gestational age was 26.5 (1.5) weeks, and the mean (SD) birth weight was 933 (243) grams. A VVR score >48 was significantly associated with severe IVH (AOR: 5.8, 95% CI: 1.2–28.9, p = 0.03), BPD (AOR: 8.8, 95% CI: 1.1–72.4, p = 0.044), prolonged mechanical ventilation (>71 days) (AOR: 6.86, 95% CI: 1.6–30, p = 0.01), and extended hospital stay (>150 days) (AOR: 6.19, 95% CI: 1.4–26.4, p = 0.01). No significant associations were observed with mortality or other outcomes. ROC curves analysis demonstrated good predictive performance of VVR score at 7 days for these adverse outcomes. Conclusion The VVR score at 7 days is a reliable predictor of significant adverse outcomes, including severe IVH and BPD, in ELGANs. Further studies in larger, diverse populations are warranted to confirm these findings.