(111) Outcomes Associated with the Targeted Treatment of Shock in Extremely Low Birthweight Infants: A Single-center NICU Experience

Background: Shock in preterm neonates can be associated with substantial morbidity and mortality. While early identification and treatment are key to successful management, prior studies have suggested that treating shock indiscriminately with vasoactive medications or pressors without hemodynamic assessment may be more harmful, with outcomes including intraventricular hemorrhage (IVH) and death. In response, targeted management of neonatal shock is increasingly being adopted by neonatologists. A 2024 study published in the Journal of Perinatology reported that echocardiography-guided selection of vasoactive medications was associated with reduced mortality and decreased incidence of severe IVH. These findings raise the possibility that targeted therapy may offer an effective approach to the management of neonatal shock.

Objectives: To compare the incidence of IVH and mortality among extremely low birthweight (ELBW) neonates in the first 72 hours in shock treated with non-targeted versus targeted therapy.

Design/Methods: We conducted a retrospective cohort study of ELBWs at a single Level IV neonatal intensive care unit (NICU) from 2013-2022. Eligible infants included those born at ≤28 weeks postmenstrual age (PMA) who exhibited hypotension or clinical signs of shock within the first 72 hours of life. Shock was identified based on hemodynamic trends, and clinical signs (defined as decreased urine output, decrease in NIRS, lethargy, metabolic acidosis, worsening oxygenation, or lethargy). Hypotension was defined as a value less than the 5th percentile per gestational age as published by Elsayed 2024.
Neonates were placed into two cohorts based on timeliness and appropriateness of intervention:
1. Targeted treatment – intervention initiated within 12 hours of hypotension with clinical evidence of shock and treatment tailored to clinical condition as per our unit guidelines
2. Non-targeted treatment – intervention within 12 hours but not per guidelines or cases where medications were administered when not hypotensive and without clinical signs of shock.
Unit guidelines focused on the targeted management of shock were developed in 2022 and retrospectively applied to infants. Primary outcomes included mortality within 14 days of shock and development of severe IVH (Grade III/IV). Statistical analysis was performed with ANOVA and chi-square where appropriate.

Results:

Conclusions: