Vasoactive-Inotropic Score and in-hospital mortality in preterm infants < 34 weeks’ gestation with early pulmonary hypertension in the setting of respiratory distress and sepsis

Purpose The Vasoactive-Inotropic Score (VIS) quantifies cardiovascular pharmacologic support intensity, but its prognostic value in preterm infants <34 weeks’ gestation with early pulmonary hypertension (PH) remains unclear. We aimed to evaluate the independent association between VISmax and in-hospital mortality in this population.Materials and methods This single-center retrospective cohort study included 238 preterm infants <34 weeks’ gestation diagnosed with early PH (≤14 postnatal days) who were hospitalized in the Department of Neonatology at Guangdong Women and Children Hospital between January 2021 and September 2024. We used the maximum Vasoactive-Inotropic Score recorded in the first 24 h after PH diagnosis (VISmax-24h) as the primary exposure. PH subtypes were retrospectively classified per Mani et al. (2024). Logistic regression with sequential models, restricted cubic splines (RCS), time-dependent Cox regression with 24h/48h landmarks, and Fine-Gray competing risk models were employed.Results Of 238 infants, 55 (23.1%) died. VISmax-24h was higher in non-survivors (median 30.0, IQR 7.5–53.5) versus survivors (median 10.0, IQR 0.0–20.0; p < 0.001). The RCS showed a linear dose-response relationship in mortality risk (P for overall association < 0.001; P for non-linearity = 0.142). After adjustment, each 10-unit increase in VISmax-24h was associated with OR 1.42 (95% CI 1.21–1.66; p < 0.001). T3 ≥ 20 versus T1 < 10 conferred adjusted OR 5.40 (95% CI 2.19–13.29; p < 0.001). Time-dependent Cox analysis confirmed persistent post-landmark associations (24h landmark: T3 vs T1 adjusted HR 2.43, 95% CI 1.13–5.19, p = 0.022). In competing risk analysis, high VIS was associated with a significantly higher hazard of severe IVH/PVL (sHR 4.67, p < 0.001), while the association with BPD was confounded by early death.Conclusions VISmax-24h is associated with in-hospital mortality in preterm infants with early PH. VISmax-24h ≥20 identifies a high risk phenotype in preterm infants with early PH and may facilitate early risk stratification and family counseling.