Multimodal Monitoring of Hemodynamics in Neonates With Extremely Low Gestational Age
Bibliographic record
Abstract
Importance: Evaluation and treatment of transitional circulation in neonates with extremely low gestational age (ELGA) varies greatly across centers. Objective: To determine whether multimodal hemodynamic monitoring in neonates with ELGA during the transitional period (first 72 hours of life) will improve cardiorespiratory-kidney health by decreasing vasoactive-ventilation-renal (VVR) score at 7 days. Design, Setting, and Participants: This unmasked, 2-arm randomized clinical trial included neonates born at a gestational age of 230 to 286 weeks and admitted to a neonatal unit in Canada. Patients were enrolled from February 15, 2019, to December 31, 2021, with follow-up completed in April 2022. Interventions: Neonates in the multimodal arm received early targeted neonatal echocardiography at 18 to 24 and 66 to 72 hours of life and cerebral near-infrared spectroscopy (NIRS) for the first 72 hours. A study guideline incorporating clinical-biochemical and cerebral near-infrared spectroscopy data was used for hemodynamic consultation in the multimodal arm. Neonates in the standard arm received hemodynamic assessment using clinical-biochemical data. Main Outcome and Measures: The primary outcome was VVR score at 7 days. The VVR score incorporates measures of inotrope use, ventilation support, and kidney function to reflect cardiorespiratory-kidney health, with possible scores ranging from 0 to 69.62 at 7 days; higher scores indicate worse cardiorespiratory-kidney health. Results: Primary analysis included 132 neonates with ELGA (68 in the multimodal arm and 64 in the standard arm) with mean (SD) gestational age of 26.4 (1.5) weeks (75 [56.8%] male). The mean (SD) VVR score at 7 days was 16.5 (15.4) in the multimodal arm and 18.9 (20.2) in the standard arm (P = .45). A day 7 peak VVR score greater than 53 (>95th percentile for VVR in the entire cohort) was seen only in the standard arm (7 of 63 [11.1%] vs 0 in the multimodal arm; P = .005) and was associated with a composite outcome of death or severe intraventricular hemorrhage (odds ratio [OR], 12.37; 95% CI, 1.92-79.63; P = .001) and bronchopulmonary dysplasia (BPD) (6 of 6 [100%] vs 55 of 116 [47.4%]; P = .01). Incidence of BPD was lower in the multimodal arm (26 of 63 [41.3%] vs 36 of 61 [59.0%]; P = .04). Logistic regression showed that VVR score at 7 days in the top quartile (adjusted OR [AOR], 11.40; 95% CI, 2.04-63.67), late sepsis (AOR, 65.24; 95% CI, 5.70-748.18), and patent ductus arteriosus treatment after 72 hours of life vs early or no treatment needed (AOR, 7.20; 95% CI, 1.60-32.41) were associated with BPD. Conclusions and Relevance: In this study of neonates with ELGA, multimodal hemodynamic assessment was not associated with decreased VVR scores at 7 days. However, this approach led to lower incidence of VVR associated with severe adverse outcomes and lower BPD incidence, suggesting further investigation is needed. Trial Registration: ClinicalTrials.gov Identifier: NCT03841929.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".