{"id":28198,"date":"2025-06-09T04:37:00","date_gmt":"2025-06-08T20:37:00","guid":{"rendered":"https:\/\/csccm.org.cn\/?p=28198"},"modified":"2025-06-09T05:40:33","modified_gmt":"2025-06-08T21:40:33","slug":"jama-netw-open%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87%ef%bc%9a%e6%9e%81%e4%bd%8e%e8%83%8e%e9%be%84%e6%96%b0%e7%94%9f%e5%84%bf%e7%9a%84%e5%a4%9a%e6%a8%a1%e6%80%81%e8%a1%80%e6%b5%81%e5%8a%a8%e5%8a%9b","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=28198","title":{"rendered":"[JAMA Netw Open\u53d1\u8868\u8bba\u6587]\uff1a\u6781\u4f4e\u80ce\u9f84\u65b0\u751f\u513f\u7684\u591a\u6a21\u6001\u8840\u6d41\u52a8\u529b\u5b66\u76d1\u6d4b"},"content":{"rendered":"\n

Original Investigation <\/p>\n\n\n\n

Pediatrics<\/p>\n\n\n\n

April 9, 2025<\/p>\n\n\n\n

Multimodal Monitoring of Hemodynamics in Neonates With Extremely Low Gestational Age: A Randomized Clinical Trial<\/h1>\n\n\n\n

Renjini Lalitha, Eyad Bitar, Matthew Hicks, et al<\/h3>\n\n\n\n

JAMA Netw Open. <\/em>2025;8(4):e254101. doi:10.1001\/jamanetworkopen.2025.4101<\/h3>\n\n\n\n

<\/a>Key Points<\/p>\n\n\n\n

Question<\/strong>  Does multimodal hemodynamic assessment during the transitional period (first 72 hours of life) improve cardiorespiratory-kidney health at 7 days in neonates with extremely low gestational age (<29 weeks\u2019 gestation)?<\/p>\n\n\n\n

Findings<\/strong>  In this randomized clinical trial of 132 neonates with extremely low gestational age, multimodal hemodynamic assessment in the first 72 hours of life compared with standard hemodynamic assessment using mostly clinical-biochemical data did not clearly improve cardiorespiratory-kidney health at 7 days of life, as suggested by the mean vasoactive-ventilation-renal scores (16.5 vs 18.9).<\/p>\n\n\n\n

Meaning<\/strong>  Multimodal hemodynamic assessment in the transitional period may have little to no effect on cardiorespiratory-kidney health at 7 days in neonates with extremely low gestational age.<\/a><\/p>\n\n\n\n

Abstract<\/p>\n\n\n\n

Importance<\/strong>  Evaluation and treatment of transitional circulation in neonates with extremely low gestational age (ELGA) varies greatly across centers.<\/p>\n\n\n\n

Objective<\/strong>  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.<\/p>\n\n\n\n

Design, Setting, and Participants<\/strong>  This unmasked, 2-arm randomized clinical trial included neonates born at a gestational age of 230<\/sup> to 286<\/sup> 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.<\/p>\n\n\n\n

Interventions<\/strong>  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.<\/p>\n\n\n\n

Main Outcome and Measures<\/strong>  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.<\/p>\n\n\n\n

Results<\/strong>\u00a0\u00a0Primary 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<\/em>\u2009=\u2009.45). 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;\u00a0P<\/em>\u2009=\u2009.005) and was associated with a composite outcome of death or severe intraventricular hemorrhage (odds ratio [OR], 12.37; 95% CI, 1.92-79.63;\u00a0P<\/em>\u2009=\u2009.001) and bronchopulmonary dysplasia (BPD) (6 of 6 [100%] vs 55 of 116 [47.4%];\u00a0P<\/em>\u2009=\u2009.01). Incidence of BPD was lower in the multimodal arm (26 of 63 [41.3%] vs 36 of 61 [59.0%];\u00a0P<\/em>\u2009=\u2009.04). 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.<\/p>\n\n\n\n

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Conclusions and Relevance<\/strong>  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.<\/p>\n\n\n\n

Trial Registration<\/strong>  ClinicalTrials.gov Identifier: NCT03841929<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

Original Investigation  Pediatrics April 9,&n […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/28198"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=28198"}],"version-history":[{"count":2,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/28198\/revisions"}],"predecessor-version":[{"id":28516,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/28198\/revisions\/28516"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=28198"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=28198"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=28198"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}