68 Multimodal Monitoring of Hemodynamics in Extremely Low Birth Weight Preterm Infants in a Canadian Tertiary Level Unit: Non-Blinded Randomized Control Trial/MUSE Trial

Abstract Introduction/Background Current approaches for the evaluation and treatment of transitional circulatory issues in preterm infants based primarily on blood pressure (BP) may be harmful. It is essential that these approaches are adequately investigated. This study tests a detailed hemodynamic approach with a multimodal assessment compared to standard approach, using a Vasoactive Ventilation Renal score (VVR) that incorporates inotrope use, ventilation support, and renal function along with inotrope use reflecting cardiorespiratory-renal health. Objectives To determine whether multimodal hemodynamic monitoring will improve cardiorespiratory-renal health as evidenced by decreasing VVR in preterm infants at one week of life. Design/Methods This was a randomized control trial of preterm infants born <29 weeks gestational age who were admitted to a tertiary neonatal intensive care unit between 15 Feb 2019 and 31 Dec 2021. Eligible infants were randomly assigned for the first 72 hours of life to either a multimodal assessment arm (consisting of early targeted neonatal echocardiogram, continuous cerebral near infrared spectroscopy [NIRS] and clinical-biochemical data) or to a standard arm (using clinical-biochemical data only). A comprehensive study guideline was used for hemodynamic assessment in the multimodal arm. Univariate and multivariate analyses compared the two arms. Results 298 infants were screened during the study period and 147 were randomly assigned (75 multimodal arm, 72 standard arm). 68 in the multimodal and 64 in the standard arm were included in the preliminary analysis (Figure 1). Baseline characteristics were similar in both arms (Table 1). The mean VVR scores within 7 days of life were 16.5(SD 15.4) and 18.9(SD 20.2) in the multimodal and standard arm respectively (p=0.451). Mean Ventilation Index scores in the first 72 hours of life were 16.2(SD 15.7) and 17.9(SD 15.5) respectively (p=0.552, Table 1). Peak VVR scores >53 at 7 days were significantly higher in the standard arm (11.1%) than in the multimodal arm (0%), p= 0.005. Outcomes of death, severe intraventricular hemorrhage and length of hospital stay were not statistically different. However, there was a trend toward decreased inotrope use in the multimodal arm compared with the standard arm (16.2% vs. 23.4% respectively, p=0.294). Conclusion In preterm infants, multimodal hemodynamic assessment during the transitional period was not associated with decreased VVR scores that signify improved cardiorespiratory-renal health, but led to lower incidence of VVR score greater than 90th centile and a decreasing trend in inotrope use in the first week of life.

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