Objective To determine the relationship between maximum vasoactive-inotropic (VIS^max) and mortality in extremely premature (<29 weeks completed gestation), extremely low birth weight (ELBW, <1000 g) infants. Study design Single center, retrospective, and observational cohort study. Results We identified 436 ELBW, 30 was associated with universal mortality. Multivariable modeling that included gestational age, birth weight, and VIS^max revealed significant utility to predict mortality with negative predictive value of 87.0% and positive predictive value of 84.8% [adjusted AUROC: 0.90, (0.86–0.94)] among patients that received vasoactive-inotropic treatment. Conclusion VIS^max is an objective measure of hemodynamic/cardiovascular support that was directly associated with mortality in extremely premature ELBW infants. The VIS^max represents an important step towards neonatal precision medicine and risk stratification of extremely premature ELBW infants.

Introduction: The neonatal sequential organ failure assessment (nSOFA) score is a tool for calculating mortality risk of infants in the neonatal intensive care unit. The utility of the nSOFA in determining the risk of mortality or the association with surgical intervention among infants with necrotizing enterocolitis (NEC) has not been investigated. Methods: We performed a retrospective, cohort study of preterm (<37 weeks) infants with NEC Bell’s stage ≥ IIA at six hospitals from 2008 to 2020. An nSOFA score (range 0–15) was assigned to each patient at nine time points from 48 h before or after clinical illness was suspected. Results: Of the 259 infants, nSOFA scores for infants who died (n = 39) or had the composite outcome of surgery or death (n = 114) were significantly higher (p < 0.05) early in the NEC course compared to nSOFA scores for infants who survived medical NEC. Twelve hours after evaluation, the area under the receiver operating characteristic curve was 0.87 (95% confidence interval [CI], 0.80–0.93) to discriminate for mortality and 0.84 (95% CI, 0.79–0.90) for surgery or death (p < 0.001). A maximum nSOFA score of ≥4 at −6, 0, 6, or 12 h following evaluation was associated with a 20-fold increase in mortality and 19-fold increase in surgery or death compared with a score of <4 (p < 0.001). Conclusion: In this multicenter cohort, the nSOFA score was able to discriminate well for death as well as surgery or death among infants with NEC. The nSOFA is a clinical research tool that may be used in infants with NEC to improve classification by objective quantification of organ dysfunction.

Within a randomized prospective pilot study of preterm infants born at less than 33 weeks’ gestation, weekly fecal samples from 19 infants were collected and metabolomic analysis was performed. The objective was to evaluate for differences in fecal metabolites in infants exposed to antibiotics vs. not exposed to antibiotics in the first 48 h after birth. Metabolomics analysis was performed on 123 stool samples. Significant differences were seen in the antibiotics vs. no antibiotics groups, including pathways related to vitamin biosynthesis, bile acids, amino acid metabolism, and neurotransmitters. Early antibiotic exposure in preterm infants may alter metabolites in the intestinal tract of preterm infants. Broader multi-omic studies that address mechanisms will guide more prudent antibiotic use in this population.