253 - Association between vasoactive inotropic score, respiratory outcomes and ECMO utilization in congenital diaphragmatic hernia

Publication Number: 4249.253

Andrew M. Beverstock, Baylor College of Medicine, Houston, TX, United States; Joseph Hagan, Baylor College of Medicine, Houston, TX, United States; Morcos Hanna, Baylor College of Medicine, Houston, TX, United States; Caraciolo Fernandes, Baylor College of Medicine, Houston, TX, United States; Sharada H. Gowda, Baylor College of Medicine, Houston, TX, United States

Background: Congenital diaphragmatic hernia (CDH) is associated with high morbidity and mortality. The CDH Study Group categorizes defects by size (A-D), which often correlates to disease severity. Affected infants often require vasoactive medication support during their hospital stay, which can be quantified by the vasoactive-inotropic score (VIS).

Objective: We sought to determine whether a higher VIS was associated with adverse outcomes, and whether defect size and laterality affected VIS.

Design/Methods: This IRB-approved single-center retrospective cohort study included 206 infants born at Texas Children's Hospital between April 2011 and December 2024. Defects were classified by surgical description at time of repair. VIS was calculated at 6, 12, and 24 hours of life. Binary logistic regression and receiver operating characteristic curves assessed associations between VIS and outcomes of mechanical ventilation at >28 days or death, EMCO or death, and tracheostomy or death. ANOVA tested for differences in VIS by defect category and laterality at each time point. A mixed-effects linear model evaluated the relationship between defect size and VIS, controlling for hour of life and accounting for repeated measures.

Results: We included 31 A, 47 B, 74 C and 34 D defects. Higher VIS at all time points was associated with increased risk of mechanical ventilation at 28 days of life (p < 0.02), the composite outcome of ECMO or death before discharge (p < 0.001), and tracheostomy or death (p < 0.03 ). Each one-point increase in VIS at 6 hours corresponded to a 17% higher odds of ECMO or death. A VIS of >1 at 24 hours of life had a 94% sensitivity, 33% specificity, and 89% negative predictive value for the composite outcome of ECMO or death.
The vasoactive-inotropic score did not differ significantly between left- and right-sided CDH defects at any time point (Table 2). Defect size was associated with VIS changes, with Type A defects showing lower scores over time than types B-D (p < 0.05, Figure 1).

Conclusion(s): Early VIS values at 6, 12, and 24 hours have predictive values for mortality and respiratory morbidity, helping guide early prognostic discussions with families. Infants with a VIS of >1 at 24 hours of life were more likely to require ECMO, whereas a value of < 1 had a high negative predictive value for ECMO need. This suggests that infants with low VIS scores are unlikely to need ECMO and may not require transfer to a higher level of care.

Table 1
Early-life association of VIS with outcomes in infants with CDH.

Table 2
Mean ± standard deviation of VIS at each time point with ANOVA p-values comparing defect side in infants who underwent CDH operative repair.

Figure 1
Mean VIS over the first 24 hours of life stratified by defect size.