Vasoactive-inotropic score as a predictor of mortality in neonatal shock: a prospective validation study in a sepsis dominant resource-limited setting

Background: Shock is an important clinical entity in critically ill neonates. Vasopressors and inotropes are mainstay of therapy. There is paucity of good quality evidence regarding the outcome of vasopressors/inotropes in neonatal shock management from Indian setting. The objective was to evaluate the maximum vasoactive-inotropic score (VISmax) an independent predictor of mortality and identify a high-risk threshold in a sepsis-dominant neonatal cohort. Methods: This prospective study enrolled 107 neonates requiring vasoactive support in a tertiary level neonatal intensive care unit. VIS max was calculated during the first 72 hours. Predictive accuracy was assessed via ROC analysis and multivariate logistic regression adjusting for birth weight and sepsis. Results: Sepsis was the primary aetiology in 70.6% of non-survivors. Non-survivors required significantly higher support (median VIS max 20 versus 10; p=0.002). A VIS max ≥20 yielded a PPV of 84.8% and specificity of 78.1% (AUC=0.690). Multivariate analysis identified Sepsis (aOR=3.965) and VIS max (aOR=1.080) as independent predictors of death (p<0.01). Conclusions: VIS max ≥20 is a critical bedside "red flag" for septic neonates, marking an 85% case fatality rate and providing a robust framework for prognostic counselling.