Association Between Vasoactive Inotropic Score and In-hospital Mortality in Preterm Neonates at <34 Weeks Gestation with Early Pulmonary Hypertension: A Single-center Retrospective Study

Association Between Vasoactive Inotropic Score and In-hospital Mortality in Preterm Neonates at <34 Weeks Gestation with Early Pulmonary Hypertension: A Single-center Retrospective Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Association Between Vasoactive Inotropic Score and In-hospital Mortality in Preterm Neonates at <34 Weeks Gestation with Early Pulmonary Hypertension: A Single-center Retrospective Study Di Zhong, Gao Weiwei, Ren Jianbing, Yang Liu, Xiao Guoliang, Chi Xiufang, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8226064/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction: The relationship between vasoactive-inotropic score (VIS) and in-hospital mortality in Preterm Neonates at <34 Weeks Gestation with Early Pulmonary Hypertension remains unclear. We aimed to clarify this relationship in preterm neonates born at <34 weeks of gestation with early pulmonary hypertension. Methods: A retrospective study was conducted on preterm infants (gestational age <34 weeks) with neonatal pulmonary hypertension who were hospitalized in the Department of Neonatology at Guangdong Women and Children's Hospital between January 2021 and September 2024. Multivariable logistic regression, restricted cubic spline, and subgroup analyzes were employed, adjusting for potential confounders. Results: A total of 238 preterm infants with early pulmonary hypertension at <34 weeks of gestation were included. After adjusting for potential confounding factors, compared with individuals in the lowest VISmax group (VISmax<30), the adjusted odds ratio (OR) for in-hospital mortality was 2.93 (95% CI: 0.9-9.49, p =0.074) in the second group (30≤VISmax<48) and 13.32 (95% CI: 4.64-38.2, p < 0.001) in the third group (48≤VISmax). Furthermore, a linear relationship was observed between VISmax and in-hospital mortality (p = 0.431), with subgroup and sensitivity analyzes confirming the stability of the results. The subgroup analysis did not reveal any significant interaction between VISmax and in-hospital mortality. Conclusion The findings of this retrospective cohort study suggest that VISmax is positively associated with mortality rate in preterm infants with early pulmonary hypertension at <34 weeks. Vasoactive Inotropic Score Mortality Preterm Pulmonary Hypertension Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction Pulmonary hypertension (PH) in preterm infants exhibits unique characteristics due to the interconnections between alveolar and vascular immaturity[1]. The phenotype of early pulmonary hypertension in preterm infants is comprised of five types that include physiologic PH, PPHN, delayed PVT, early PH, and flow-associated PH[2]. Pulmonary hypertension is being increasingly recognized in infants born preterm and is associated with mortality, BPD, and longterm cardiorespiratory morbidity[3]. The prevalence of early PH in preterm infants is variable, ranging between 8% and 55% based on gestational age or birth weight cutoff chosen for prematurity and timing of echocardiography[4,5]. Early-onset PH occurs at birth or during the first weeks of life and may exhibit very different pathophysiologies with either increased pulmonary vascular resistance (PVR) such as observed in persistent neonatal PH (PPHN) or with postnatal decreased PVR such as observed in PH associated with increased pulmonary blood flow (PBF) due to left-to-right shunting through a patent ductus arteriosus (PDA)[6]. A recent meta-analysis to identify the risk factors associated with PH in preterm infants diagnosed within 2 weeks of life using clinical and echocardiographic criteria determined that oligohydramnios and small for gestational age (SGA) are strong predictors of early PH in preterm infants[7]. Systemic hypotension in early PH may be secondary to elevated PVR, increasing the RV afterload and decreasing PBF. This, in turn, leads to decreased LV preload[8]. Low systemic vascular resistance (SVR) and systemic hypotension requiring treatment are common in infants with PPHN. Two-thirds of infants with PPHN requiring ventilation and 87% of infants requiring ECMO are on 3 or more inotropes.[9] Several vasoactive medications may be useful to treat hypotension associated with PPHN in neonates. Indeed, the necessity and degree of hemodynamic support with vasoactive drugs is frequently considered as a marker of disease severity, and it is well established that mortality rates increase when high doses of vasoactive drugs are required[10]. The Vasoactive Inotropic score (VIS) has been used to measure illness severity in neonates and infants undergoing congenital heart surgery, septic pediatric patients admitted to the pediatric intensive care unit (PICU), or mortality in extremely premature (29 weeks completed gestation) and extremely low birth weight (ELBW, < 1000 g) infants[11–13]. In these studies, the vasopressor dose load, VIS, and maximum VIS (VISmax) exhibited a direct relationship between the need for vasoactive-inotropic medications and the risk of morbidity and mortality. We aimed to determine the association between VISmax and the risk of mortality in Preterm Neonates at < 34 weeks of gestation with early pulmonary hypertension. Methods Data source and study population This study was a retrospective cohort study. Preterm infants as < 34 weeks gestation with early pulmonary hypertension who had been admitted to the NICU of the Guangdong Women and Children Hospital between January 2021 to September 2024 were identified.Guangdong Women and Children Hospital is a Class Ⅲ Grade A hospital in Guangdong Province, China, with approximately 15,000 annual deliveries, 70% of which involve high-risk pregnancies. Its Department of Neonatology serves as one of the largest neonatal treatment centers in South China, admitting over 8,000 patients annually. The present study conformed to the principles of the Declaration of Helsinki. This study was approved by the Ethics Committee of Guangdong Women and Children's Hospital (202301194). Electronic medical records confirmed all clinical data, and two trained physicians collected the data. We collected information detailing maternal, neonatal, and vasoactive-inotropic medication exposure. Definitions of early PH Early onset PH was diagnosed in the first two weeks after birth and included PPHN, defined as the presence of a (predominantly) right-to-left shunt through an open foramen ovale (OFO) and/or PDA as determined by echocardiography and clinically by a preductal and postductal difference in transcutaneous oxygen saturation (tcSO2) of greater than 10%[14]. Flowassociated PH (flow PH) is defined as a nonrestrictive (Vmax < 2.0 m/s) (predominantly) left-to-right shunt through a PDA, as revealed by echocardiography. [15] All echocardiograms were performed by certified sonographers. The images were then interpreted and diagnoses were made by neonatologists who integrated the echocardiographic findings with the clinical history. The maximum vasoactive-inotropic score (VISmax) The daily Vasoactive-Inotropic Score (VIS) was calculated for each neonate from birth until the end of the first week following the diagnosis of pulmonary hypertension (PH). The score was calculated using the formula: VIS = dopamine dose (µg/kg/min) + dobutamine dose (µg/kg/min) + 100 × epinephrine dose (µg/kg/min) + 100 × norepinephrine dose (µg/kg/min) + 10 × milrinone dose (µg/kg/min). The exposure variable of interest was the VISmax, defined as the highest single-day VIS score recorded during this period (from birth to one week post-PH diagnosis). This time window was chosen to capture the peak of hemodynamic instability associated with the diagnosis and initial management of PH. The exclusion criteria included the following: (1) suspected or confirmed chromosomal abnormality or other congenital malformations; (2) congenital heart disease requiring surgery; (3) congenital diaphragmatic hernia; (4) physiologic pulmonary hypertension and no need for invasive respiratory support; (5) medical records were incomplete. A detailed flow chart of subjects is shown in Fig. 1 . Covariates According to the prior literature requirements, various potential covariates were assessed. Key demographic and clinical variables had no missing data. For covariates with missing data, such as white blood cell count(WBC) (missing 8.2%), platelet count(PLT) (missing 8.2%), Procalcitonin (PCT) (missing 8.2%), C-reactive protein (CRP)(missing 8.2%)(table S1-S2). The multiple imputation method utilized was a fully conditional specification (FCS) implemented by the MICE algorithm, as described by Van Buuren and Groothuis Oudshoorn (2011). The follow-up period for assessing all secondary clinical outcomes was defined as the duration from birth until the first occurrence of one of the following events: hospital discharge, death, or transfer to another tertiary care facility. Outcomes such as bronchopulmonary dysplasia (BPD) were assessed at 36 weeks' postmenstrual age (PMA) for infants who remained hospitalized at that time. Statistical analysis This study aimed to observe the impact of the VISmax score on hospital mortality in preterm neonates born at < 34 weeks of gestation with early pulmonary hypertension. The patients were divided into three groups based on their VISmax scores (VIS1: VISmax < 30, VIS2: 30 ≤ VISmax < 48, VIS3: 48 ≤ VISmax)[12,16]. Descriptive analysis was applied to all patients. Continuous data are expressed as mean and standard deviation (SD) or median and interquartile range (IQR) (quartile 1-quartile 3 [interquartile range]), as appropriate. Categorical variables are expressed as proportions (%). Variables were compared using the chisquare test (categorical variables), one-way ANOVA (normal distribution), and Kruskal–Wallis (skewed distribution). Multivariate logistic regression analysis was used to assess the independent association between VISmax scores and hospital mortality. It was the appropriate method for our binary primary outcome. Confounding factors were an important issue in the analysis, and we used different statistical models to verify the stability of the results. In the final model, we adjusted the factors based on the following rules. For the multivariate analysis, variables were chosen based on previous findings and clinical constraints. Survival curves were plotted using Kaplan-Meier and log-rank analyzes. Additionally, exploratory subgroup analyzes were performed based on gestational age, birth weight and gender. Statistical analyzes were conducted in R (version 4.2.1) (R Foundation for Statistical Computing) with the "survey" package (version 4.1-1) and Free Statistics software (version 1.9.25). A two-tailed p < 0.05 was utilized to signify statistical significance in all analyzes. Results Study population and baseline characteristics Of the 238 preterm neonates born at 0, 45 experienced the VISmax within one calendar day of birth; all of them had the VISmax within 7 calendar days of birth. In this cohort, platelet levels at admission were skewed and distributed. Baseline characteristics of the study population according to survival states and VISmax scores are presented in Tables 1 and 2 . The gestational age and the birth weight of the survival group were 30.6 ± 2.5 weeks and 1486.1 ± 498.1 grams, while those of the mortality group were 28.4 ± 2.8 weeks and 1094.7 ± 399.9 grams. The mortality group exhibited lower PLT and lower WBC within 3 days after birth. In the mortality group, 47.3% of the infants received dexamethasone before delivery, and 70.9% received inhaled nitric oxide. In the VISmax score group, there were no significant differences in gestational age at birth and birth weight. Table 1 Baseline characteristics of the study participants. Variables Total (n = 238) Survival group (n = 183) Death group (n = 55) GA, Mean ± SD 30.1 ± 2.7 30.6 ± 2.5 28.4 ± 2.8 GAgroup, n (%) GA ≤ 28W 56 (23.5) 30 (16.4) 26 (47.3) 28 < GA ≤ 32 110 (46.2) 88 (48.1) 22 (40) 32 < GA ≤ 34 72 (30.3) 65 (35.5) 7 (12.7) BW, Mean ± SD 1395.6 ± 504.3 1486.1 ± 498.1 1094.7 ± 399.9 BWgroup, n (%) BW ≤ 1000g 50 (21.0) 26 (14.2) 24 (43.6) 1000 < BW ≤ 1500 97 (40.8) 77 (42.1) 20 (36.4) 1500 < BW 91 (38.2) 80 (43.7) 11 (20) Gender, n (%) female 101 (42.4) 77 (42.1) 24 (43.6) male 137 (57.6) 106 (57.9) 31 (56.4) Apgar score, n (%) Apgar score < 8 62 (26.1) 36 (19.7) 26 (47.3) 8 ≤ Apgar score 176 (73.9) 147 (80.3) 29 (52.7) Delivery method, n (%) Cesarean section 149 (62.6) 124 (67.8) 25 (45.5) vaginal delivery 89 (37.4) 59 (32.2) 30 (54.5) Prolonged rupture of membranes, n (%) No 188 (79.0) 148 (80.9) 40 (72.7) Yes 50 (21.0) 35 (19.1) 15 (27.3) IVF, n (%) No 201 (84.5) 155 (84.7) 46 (83.6) Yes 37 (15.5) 28 (15.3) 9 (16.4) Maternal Hypertensive disease, n (%) No 196 (82.4) 154 (84.2) 42 (76.4) Yes 42 (17.6) 29 (15.8) 13 (23.6) Maternal diabetes, n (%) No 171 (71.8) 128 (69.9) 43 (78.2) Yes 67 (28.2) 55 (30.1) 12 (21.8) Antenatal steroids given, n (%) No 90 (37.8) 61 (33.3) 29 (52.7) Yes 148 (62.2) 122 (66.7) 26 (47.3) Suspected chorioamnionitis, n (%) No 222 (93.3) 170 (92.9) 52 (94.5) Yes 16 ( 6.7) 13 (7.1) 3 (5.5) Delivery Room Resuscitation, n (%) No 221 (92.9) 172 (94) 49 (89.1) Yes 17 ( 7.1) 11 (6) 6 (10.9) WBC group, n (%) WBC ≤ 5×10 9 /L 56 (23.5) 36 (19.7) 20 (36.4) 5×10 9 /L < WBC ≤ 30×10 9 /L 169 (71.0) 138 (75.4) 31 (56.4) 30×10 9 /L < WBC 13 ( 5.5) 9 (4.9) 4 (7.3) CRPgroup, n (%) CRP < 10 mg/l 158 (66.4) 121 (66.1) 37 (67.3) 10mg/l < CRP 80 (33.6) 62 (33.9) 18 (32.7) PLTgroup, n (%) PLT < 100×10 12 /L 23 ( 9.7) 12 (6.6) 11 (20) 100×10 12 /L < PLT 215 (90.3) 171 (93.4) 44 (80) PCTgroup, n (%) PCT < 10ng/L 155 (65.1) 118 (64.5) 37 (67.3) 10ng/L < PCT 83 (34.9) 65 (35.5) 18 (32.7) iNO, n (%) No 146 (61.3) 130 (71) 16 (29.1) Yes 92 (38.7) 53 (29) 39 (70.9) Sildenafil, n (%) No 218 (91.6) 175 (95.6) 43 (78.2) Yes 20 ( 8.4) 8 (4.4) 12 (21.8) corticosteroid use after iNO, n (%) No 198 (83.2) 166 (90.7) 32 (58.2) Yes 40 (16.8) 17 (9.3) 23 (41.8) Treprostinil sodium, n (%) No 231 (97.1) 182 (99.5) 49 (89.1) Yes 7 ( 2.9) 1 (0.5) 6 (10.9) VIS group(%) VIS1 170(71.4) 145 (85.3) 25 (14.7) VIS2 31(13.0) 23 (74.2) 8 (25.8) VIS3 37(15.5) 15 (40.5) 22 (59.5) Table 2 Population characteristics categorized by VIS score. Variables Total (n = 238) VIS1 (n = 170) VIS2 (n = 31) VIS3 (n = 37) GA, Mean ± SD 30.1 ± 2.7 30.0 ± 2.7 30.1 ± 3.0 30.4 ± 2.5 GA group, n (%) GA ≤ 28W 56 (23.5) 41 (24.1) 7 (22.6) 8 (21.6) 28 < GA ≤ 32 110 (46.2) 78 (45.9) 14 (45.2) 18 (48.6) 32 < GA ≤ 34 72 (30.3) 51 (30) 10 (32.3) 11 (29.7) BW, Mean ± SD 1395.6 ± 504.3 1380.7 ± 490.6 1411.6 ± 496.5 1450.8 ± 578.3 BW group, n (%) BW ≤ 1000g 50 (21.0) 36 (21.2) 6 (19.4) 8 (21.6) 1000 < BW ≤ 1500 97 (40.8) 71 (41.8) 11 (35.5) 15 (40.5) 1500 < BW 91 (38.2) 63 (37.1) 14 (45.2) 14 (37.8) Gender, n (%) female 101 (42.4) 75 (44.1) 12 (38.7) 14 (37.8) male 137 (57.6) 95 (55.9) 19 (61.3) 23 (62.2) Apgar score, n (%) Apgar score < 8 62 (26.1) 39 (22.9) 10 (32.3) 13 (35.1) 8 ≤ Apgar score 176 (73.9) 131 (77.1) 21 (67.7) 24 (64.9) Delivery method, n (%) Cesarean section 149 (62.6) 102 (60) 26 (83.9) 21 (56.8) vaginal delivery 89 (37.4) 68 (40) 5 (16.1) 16 (43.2) Prolonged rupture of membranes, n (%) No 188 (79.0) 136 (80) 22 (71) 30 (81.1) Yes 50 (21.0) 34 (20) 9 (29) 7 (18.9) IVF, n (%) No 201 (84.5) 143 (84.1) 27 (87.1) 31 (83.8) Yes 37 (15.5) 27 (15.9) 4 (12.9) 6 (16.2) Maternal hypertensive disease, n (%) No 196 (82.4) 137 (80.6) 28 (90.3) 31 (83.8) Yes 42 (17.6) 33 (19.4) 3 (9.7) 6 (16.2) Maternal diabetes, n (%) No 171 (71.8) 119 (70) 23 (74.2) 29 (78.4) Yes 67 (28.2) 51 (30) 8 (25.8) 8 (21.6) Antenatal steroids given, n (%) No 90 (37.8) 59 (34.7) 12 (38.7) 19 (51.4) Yes 148 (62.2) 111 (65.3) 19 (61.3) 18 (48.6) Suspected chorioamnionitis, n (%) No 222 (93.3) 158 (92.9) 28 (90.3) 36 (97.3) Yes 16 ( 6.7) 12 (7.1) 3 (9.7) 1 (2.7) Delivery Room Resuscitation, n (%) No 221 (92.9) 161 (94.7) 26 (83.9) 34 (91.9) Yes 17 ( 7.1) 9 (5.3) 5 (16.1) 3 (8.1) WBC group, n (%) WBC ≤ 5×10 9 /L 56 (23.5) 35 (20.6) 9 (29) 12 (32.4) 5×10 9 /L < WBC ≤ 30×10 9 /L 169 (71.0) 127 (74.7) 21 (67.7) 21 (56.8) 30×10 9 /L < WBC 13 ( 5.5) 8 (4.7) 1 (3.2) 4 (10.8) CRP group, n (%) CRP < 10 mg/l 135 (56.7) 102 (60) 13 (41.9) 20 (54.1) 10mg/l < CRP 103 (43.3) 68 (40) 18 (58.1) 17 (45.9) PLT group, n (%) PLT < 100×10 12 /L 23 ( 9.7) 15 (8.8) 3 (9.7) 5 (13.5) 100×10 12 /L < PLT 215 (90.3) 155 (91.2) 28 (90.3) 32 (86.5) PCT group, n (%) PCT < 10ng/L 155 (65.1) 123 (72.4) 14 (45.2) 18 (48.6) 10ng/L < PCT 83 (34.9) 47 (27.6) 17 (54.8) 19 (51.4) iNO, n (%) No 146 (61.3) 131 (77.1) 13 (41.9) 2 (5.4) Yes 92 (38.7) 39 (22.9) 18 (58.1) 35 (94.6) corticosteroid use, n (%) No 198 (83.2) 167 (98.2) 21 (67.7) 10 (27) Yes 40 (16.8) 3 (1.8) 10 (32.3) 27 (73) Treprostinilsodium,n (%) No 231 (97.1) 170 (100) 29 (93.5) 32 (86.5) Yes 7 ( 2.9) 0 (0) 2 (6.5) 5 (13.5) Sildenafil, n (%) No 218 (91.6) 168 (98.8) 25 (80.6) 25 (67.6) Yes 20 ( 8.4) 2 (1.2) 6 (19.4) 12 (32.4) VIS, Median (IQR) 10.0 (0.0, 30.0) 5.0 (0.0, 12.5) 35.0(30.0, 40.0) 63.0 (50.0, 90.0) statement, n (%) Survival group 183 (76.9) 145 (85.3) 23 (74.2) 15 (40.5) death group 55 (23.1) 25 (14.7) 8 (25.8) 22 (59.5) Relationship between VISmax and in-hospital mortality In the multivariate logistic regression analysis, the VISmax score was divided into three groups (VIS1: VISmax < 30, VIS2: 30 ≤ VISmax < 48, and VIS3: 48 ≤ VISmax), and after accounting for potential confounding factors, a significant positive correlation was observed between VISmax and death. In comparison to individuals in VIS1, the adjusted odds ratios (OR) for death were 2.39 (95% CI: 0.67–8.57, p = 0.181) in the second group (VIS2) and 10.6 (95% CI: 2.67–42.13, p = 0.001) in the third group (VIS3)(Table 3 ).The spline analysis supported a linear association with the VISmax and hospital mortality within this population (p = 0.431 for non-linearity, Fig. 2 ). Table 3 Association between VISmax scores and in‑hospital mortality in multiple regression model. Model 1 Model 2 Model 3 Model 4 OR (95%CI) P value OR (95%CI) P value OR (95%CI) P value OR (95%CI) P value Trend test 2.83 (1.93 ~ 4.16) < 0.001 3.61 (2.3 ~ 5.67) < 0.001 3.63 (2.22 ~ 5.95) < 0.001 3.6 (2.14 ~ 6.07) < 0.001 VIS1 1(Ref) 1(Ref) 1(Ref) 1(Ref) VIS2 2.02 (0.81 ~ 5.01) 0.13 2.52 (0.91 ~ 6.93) 0.008 3.07 (0.98 ~ 9.6) 0.054 2.93 (0.9 ~ 9.49) 0.074 VIS3 8.51 (3.89 ~ 18.59) < 0.001 13.83 (5.54 ~ 34.51) < 0.001 13.5 (4.99 ~ 36.57) < 0.001 13.32 (4.64 ~ 38.2) < 0.001 Model 1: no adjusted; Model 2 was adjusted for gestational age, birth weight, gender; Model 3 was adjusted for Model 2 + Delivery method, Prolonged rupture of membranes, Maternal hypertensive disease, Maternal diabetes + Antenatal steroids given, Suspected chorioamnionitis + Delivery Room Resuscitation,1min Apgarscore; Model 4 was adjusted for Model 3 + WBC, CRP, PLT, PCT; Stratified analyzes based on additional variables and survival analysis Stratified analyzes of multiple subgroups revealed no significant interactions when stratified by BW, GA, gender.(Fig. 3 ) Given the sample size, these subgroup analyzes should be interpreted with caution as exploratory findings to inform future research Fig. 4 depicts the Kaplan-Meier survival estimates for hospital mortality stratified by VISmax. Notably, the group with lower VISmax exhibited a higher survival rate in relation to early pulmonary hypertension. sensitivity analyzes were performed by excluding individuals with missing covariates. Similar results were obtained after adjusting the model for multivariate logistic and restricted cubic spline analyzes(table S3). Relationship between VISmax and clinical outcomes There was no significant difference in the incidence of BPD, NEC, ROP, PVL, and other adverse clinical outcomes among the three VIS groups of children after treatment, but there were significant differences in pulmonary hemorrhage, respiratory support, oxygen therapy, and length of hospital stay(Table 4 ). The comparison of clinical outcomes in the survival group was performed separately to account for the potential for bias in complications in the presence of death(Table 5 ). The results indicated significant differences in pulmonary hemorrhage and duration of respiratory support (P < 0.05). Table 4 Clinical outcomes categorized by VIS score. Variables Total (n = 238) VIS1 (n = 170) VIS2 (n = 31) VIS3 (n = 37) p statistic BPD, n (%) 0.229 2.949 No 173 (72.7) 119 (70) 23 (74.2) 31 (83.8) Yes 65 (27.3) 51 (30) 8 (25.8) 6 (16.2) NEC, n (%) 0.506 Fisher No 215 (90.3) 152 (89.4) 30 (96.8) 33 (89.2) Yes 23 ( 9.7) 18 (10.6) 1 (3.2) 4 (10.8) ROP, n (%) 0.271 Fisher No 232 (97.5) 167 (98.2) 30 (96.8) 35 (94.6) Yes 6 ( 2.5) 3 (1.8) 1 (3.2) 2 (5.4) Pulmonary hemorrhage, n (%) 0.006 Fisher No 211 (88.7) 156 (91.8) 28 (90.3) 27 (73) Yes 27 (11.3) 14 (8.2) 3 (9.7) 10 (27) Grade 3–4 IVH or PVL, n (%) 0.291 Fisher No 205 (86.1) 150 (88.2) 25 (80.6) 30 (81.1) Yes 33 (13.9) 20 (11.8) 6 (19.4) 7 (18.9) Duration of mechanical ventilation, Median (IQR) 6.6 (3.7, 9.6) 6.4 (3.8, 9.7) 8.0 (6.1, 9.1) 4.7 (2.5, 8.4) 0.118 4.268 Duration of any airway pressure support, Median (IQR) 13.5 (6.9, 29.6) 15.6 (7.6, 34.6) 13.5 (10.2, 22.7) 7.4 (2.5, 11.8) < 0.001 19.222 Duration of oxygen therapy, Median (IQR) 17.8 (8.0, 49.1) 26.8 (10.6, 55.0) 15.6 (10.2, 47.6) 7.4 (2.5, 13.3) < 0.001 25.034 Duration of hospitalization, Median (IQR) 35.9 (17.0, 61.6) 42.5 (22.0, 67.3) 36.8 (14.7, 58.5) 10.8 (2.6, 28.4) < 0.001 28.654 Table 5 Clinical outcomes categorized by VIS score in survival group. Variables Total (n = 183) VIS1 (n = 145) VIS2 (n = 23) VIS3 (n = 15) p statistic BPD, n (%) 0.52 1.308 No 122 (66.7) 95 (65.5) 15 (65.2) 12 (80) Yes 61 (33.3) 50 (34.5) 8 (34.8) 3 (20) NEC, n (%) 0.499 Fisher No 168 (91.8) 131 (90.3) 22 (95.7) 15 (100) Yes 15 ( 8.2) 14 (9.7) 1 (4.3) 0 (0) ROP, n (%) 0.072 Fisher No 177 (96.7) 142 (97.9) 22 (95.7) 13 (86.7) Yes 6 ( 3.3) 3 (2.1) 1 (4.3) 2 (13.3) Grade 3 4 IVH or PVL, n (%) 0.903 Fisher No 164 (89.6) 130 (89.7) 20 (87) 14 (93.3) Yes 19 (10.4) 15 (10.3) 3 (13) 1 (6.7) Pulmonary hemorrhage, n (%) 0.009 Fisher No 172 (94.0) 139 (95.9) 22 (95.7) 11 (73.3) Yes 11 ( 6.0) 6 (4.1) 1 (4.3) 4 (26.7) Duration of mechanical ventilation, Median (IQR) 7.1 (4.3, 9.8) 6.5 (4.0, 9.7) 8.1 (7.0, 10.0) 7.9 (6.3, 10.3) 0.024 7.439 Duration of any airway pressure support, Median (IQR) 17.4 (10.8, 34.4) 18.6 (10.1, 36.2) 19.3 (12.7, 26.8) 11.0 (10.4, 18.3) 0.189 3.336 Duration of oxygen therapy, Median (IQR) 31.6 (12.1, 55.8) 33.7 (13.2, 61.5) 34.4 (13.2, 52.0) 12.2 (10.8, 29.3) 0.09 4.811 Duration of hospitalization, Mean ± SD 49.9 ± 25.7 51.1 ± 25.1 51.6 ± 29.7 35.4 ± 21.0 0.073 2.651 Discussion Previous studies have predominantly focused on BPD related to pulmonary hypertension and have paid little attention to the systemic hypotension associated with pulmonary hypertension and the resulting hospital mortality rate. Our study is an essential initial, exploratory investigation into investigating the impact of VISmax scores on in-hospital mortality in preterm infants with pulmonary hypertension before 34 weeks of gestation. This retrospective study yielded the following findings: (1) A VISmax level of higher than 48 was associated with an increased risk of death, and VISmax was positively correlated with the mortality rate in preterm infants with pulmonary hypertension before 34 weeks; (2) Among survivors, a higher VIS score was associated with an increased incidence of pulmonary hemorrhage, longer duration of mechanical ventilation, prolonged oxygen dependency, and extended hospital stay. Recent epidemiological and physiological studies have demonstrated an even greater incidence of PPHN in preterm infants than in newborns delivered at term, and this is strongly associated with prematurity severity and a 3.5-fold increase in mortality[17,18]. When children with pulmonary hypertension develop hypoxemia accompanied by systemic hypotension, vasopressors are typically used for blood pressure management. However, different vasoactive drugs exert varying effects on pulmonary artery pressure[19–21]. Clinicians may have different choices of vasoactive drugs when dealing with patients of different phenotypes of pulmonary arterial hypertension. The VISmax was an easily quantifiable measure of vasoactive-inotropic support. The direct association between VISmax and death risk in our PH premature cohort was similar to that of other studies examining children and adults. Gaies et al. reported that a VISmax of 20–24 in the first 24 hours or a VISmax of 15–19 in the subsequent 48 hours post congenital heart surgery in infants was associated with a higher risk of death (in-hospital or within 30 days of discharge), cardiac arrest, need for mechanical circulatory support, need for renal replacement therapy, or central nervous system injury relative to the "low risk" group (VISmax 20 was associated with 100% mortality[23]. Our study determined that VISmax was positively correlated with mortality in PH of preterm infants at < 34 gestation. This study also demonstrated that VISmax were related to increased mortality after adjusting for various potential covariates. Smooth line analysis of the generalized additive model revealed a linear relationship between VISmax and mortality. Our subgroup analysis showed no interaction between VISmax and death across subgroups, and survival analysis indicated that the group with lower VISmax scores exhibited a higher survival rate. The initial period following PH diagnosis is often the most unstable, representing the severity of the underlying cardiorespiratory illness.A multicenter prospective observational cohort study revealed that the median age at iNO initiation was on day 1 of life in very preterm neonates with pulmonary hypertension.In the early acute pulmonary hypertension group, mortality was associated with lower GA and birth weight, less use of antenatal corticosteroids, higher incidence of prolonged rupture of membranes and increased pre-iNO vasoactive drug use.[24] This study focuses more specifically than prior literature on the therapeutic demand for vasoactive agents in addressing systemic perfusion hypotension subsequent to pulmonary hypertension (PH).Of note, there is no unified standard for the maximum dosage of combining different vasoactive drugs. We still do not possess a clear understanding of the limit. Furthermore, in the analysis of clinical outcomes, we observed a higher incidence of pulmonary hemorrhage in the group receiving higher doses of vasoactive medications. We hypothesize that this phenomenon is related to the pathophysiological alterations in pulmonary hypertension: in severe cases, the reduction of pulmonary arterial pressure concurrently leads to changes in shunt direction through the ductus arteriosus, thereby increasing left ventricular preload. This results in elevated pulmonary venous pressure and venous congestion, ultimately contributing to pulmonary hemorrhage. Paradoxically, the administration of excessive vasoactive drugs may potentially exacerbate this phenomenon[25].Fortunately, the widespread application of bedside critical ultrasound for premature infants may provide significant assistance for guiding the use of vasoactive drugs for these patients. In future studies, the use of vasoactive drugs in these patients will become more refined, and the survival rate will increase. This study possesses several important limitations. First, its single-center, retrospective design inherently limits the generalizability of our findings and introduces potential for selection and observer bias. While we employed strict, pre-defined criteria for patient inclusion and echocardiographic diagnosis, practice patterns and patient populations at other centers may yield different results. Our findings should be considered hypothesis-generating and require validation in larger, prospective, multi-center studies. Second, while we addressed missing data using multiple imputation and demonstrated the robustness of our primary result through sensitivity analysis, the possibility that data were not missing at random cannot be entirely excluded. This remains a limitation inherent to observational data. Third, we conducted exploratory subgroup analyzes to assess the consistency of the association between VISmax and in-hospital mortality across key patient characteristics. Although no significant interactions were found (all interaction p-values > 0.10), the direction of the hazard ratio was consistent in subgroups defined by gestational age, birth weight, and gender. This finding requires confirmation in larger, dedicated cohorts. Although we used the highest VIS value over a specified period, the relationship between the timing of VISmax occurrence and clinical outcomes in this population presents a compelling area for further investigation. We were unable to determine the temporal association between VISmax and PH mortality. This question would require a larger dataset and sample size for robust analysis. Further prospective studies are required to confirm our findings. Conclusion The findings of this retrospective cohort study suggest that VISmax is positively associated with mortality rate in preterm infants with pulmonary hypertension at < 34 weeks of age. Declarations Statement of Ethics The studies were reviewed and approved by the Medical Ethics Committee of Guangdong Women and Children Hospital.The ethics committee waived the requirement of written informed consent for participation. Conflict of Interest Statement The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.The authors have no conflicts of interest to declare. Funding Sources This project was supported by Guangdong Basic and Applied Basic Research Foundation(No:2025A1515012722, 2023A1515010674),Guangzhou Science and Technology Project༈No:2025A03J4281, 2024B03J1297༉ Author Contribution DZ conducted the data collection and analysis. YL wrote the manuscript. GWW and DZ modified the manuscript. CXF conducted the data interpretation. ZD drew the figure. YL and XGL conducted the data collection. CXF made the table. NC designed the study and reviewed the manuscript. All authors contributed to the article and approved the submitted version. Acknowledgement We thank all patients and staff who agreed to participate in this study. We sincerely thank the reviewers of this article. Their valuable suggestions have substantially helped to improve this article. Data Availability The raw data required to reproduce these findings cannot be shared at this time as the data also form part of an ongoing study. If necessary, some or all data generated or used during the study are available from the corresponding author by request. References Abman SH, Hansmann G, Archer SL, Ivy DD, Adatia I, Chung WK, et al. Pediatric pulmonary hypertension: guidelines from the american heart association and american thoracic society. Circulation. 2015 Nov;132(21):2037–99. Mani S, Mirza H, Ziegler J, Chandrasekharan P. Early Pulmonary Hypertension in Preterm Infants. Clinics in Perinatology. 2023 Dec;S0095510823001100. Collaco JM, Romer LH, Stuart BD, Coulson JD, Everett AD, Lawson EE, et al. Frontiers in Pulmonary Hypertension in Infants and Children With Bronchopulmonary Dysplasia. Pediatr Pulmonol. 2012 Nov;47(11):1042–53. Arjaans S, Fries MWF, Schoots MH, Schilte CFM, Roofthooft MTR, Vrijlandt EJLE, et al. Clinical significance of early pulmonary hypertension in preterm infants. J Pediatr. 2022 Dec;251:74-81.e3. Abman SH. The 13th Bengt Robertson Memorial Lecture: Pulmonary Hypertension: the Hidden Danger for Newborns. Neonatology. 2021;118(2):211–7. Arjaans S, Zwart ElviraAH, Roofthooft M, Kooi EMW, Bos AF, Berger RMF. Pulmonary hypertension in extremely preterm infants: a call to standardize echocardiographic screening and follow-up policy. Eur J Pediatr. 2021 Jun;180(6):1855–65. Storme L, Aubry E, Rakza T, Houeijeh A, Debarge V, Tourneux P, et al. Pathophysiology of persistent pulmonary hypertension of the newborn: impact of the perinatal environment. Archives of Cardiovascular Diseases. 2013 Mar;106(3):169–77. Siefkes HM, Lakshminrusimha S. Management of systemic hypotension in term infants with persistent pulmonary hypertension of the newborn (PPHN) – an illustrated review. Arch Dis Child Fetal Neonatal Ed. 2021 Jul;106(4):446–55. Mydam J, Zidan M, Chouthai NS. A comprehensive study of clinical biomarkers, use of inotropic medications and fluid resuscitation in newborns with persistent pulmonary hypertension. Pediatr Cardiol. 2015 Jan;36(1):233–9. Belletti A, Lerose CC, Zangrillo A, Landoni G. Vasoactive-inotropic score: evolution, clinical utility, and pitfalls. Journal of Cardiothoracic and Vascular Anesthesia. 2021 Oct;35(10):3067–77. Brand DA, Patrick PA, Berger JT, Ibrahim M, Matela A, Upadhyay S, et al. Intensity of Vasopressor Therapy for Septic Shock and the Risk of In-Hospital Death. Journal of Pain and Symptom Management. 2017 May;53(5):938–43. Aziz KB, Lavilla OC, Wynn JL, Lure AC, Gipson D, de la Cruz D. Maximum vasoactive-inotropic score and mortality in extremely premature, extremely low birth weight infants. J Perinatol : Off J Calif Perinat Assoc. 2021 Sep;41(9):2337–44. Butts RJ, Scheurer MA, Atz AM, Zyblewski SC, Hulsey TC, Bradley SM, et al. Comparison of maximum vasoactive inotropic score and low cardiac output syndrome As markers of early postoperative outcomes after neonatal cardiac surgery. Pediatr Cardiol. 2012 Apr;33(4):633–8. Lakshminrusimha S, Keszler M. Persistent pulmonary hypertension of the newborn. Neoreviews. 2015 Dec;16(12):e680–92. Lai GY, Shlobin N, Garcia RM, Wescott A, Kulkarni AV, Drake J, et al. Global incidence proportion of intraventricular haemorrhage of prematurity: a meta-analysis of studies published 2010–2020. Arch Dis Child - Fetal Neonatal Ed. 2022 Sep;107(5):513–9. Koponen T, Karttunen J, Musialowicz T, Pietiläinen L, Uusaro A, Lahtinen P. Vasoactive-inotropic score and the prediction of morbidity and mortality after cardiac surgery. Br J Anaesth. 2019 Apr;122(4):428–36. Nakanishi H, Suenaga H, Uchiyama A, Kusuda S. Persistent pulmonary hypertension of the newborn in extremely preterm infants: a Japanese cohort study. Arch Dis Child - Fetal Neonatal Ed. 2018 Nov;103(6):F554–61. Morbidity of persistent pulmonary hypertension of the newborn in the first year of life - PubMed [Internet]. [cited 2025 May 30]. Available from: https://pubmed.ncbi.nlm.nih.gov/31399244/ Liet J-M, Boscher C, Gras-Leguen C, Gournay V, Debillon T, Rozé J-C. Dopamine effects on pulmonary artery pressure in hypotensive preterm infants with patent ductus arteriosus. J Pediatr. 2002 Mar;140(3):373–5. Jaillard S, Elbaz F, Bresson-Just S, Riou Y, Houfflin-Debarge V, Rakza T, et al. Pulmonary vasodilator effects of norepinephrine during the development of chronic pulmonary hypertension in neonatal lambs. Br J Anaesth. 2004 Dec;93(6):818–24. Tourneux P, Rakza T, Bouissou A, Krim G, Storme L. Pulmonary circulatory effects of norepinephrine in newborn infants with persistent pulmonary hypertension. J Pediatr. 2008 Sep;153(3):345–9. Gaies MG, Gurney JG, Yen AH, Napoli ML, Gajarski RJ, Ohye RG, et al. Vasoactive–inotropic score as a predictor of morbidity and mortality in infants after cardiopulmonary bypass*: Pediatr Crit Care Med. 2010 Mar;11(2):234–8. Haque A, Siddiqui NR, Munir O, Saleem S, Mian A. Association between vasoactive-inotropic score and mortality in pediatric septic shock. Indian Pediatr. 2015 Apr;52(4):311–3. Baczynski M, Weisz D, Thomas L, Fevrier S, Castaldo M, Soraisham A, et al. Response to inhaled nitric oxide and mortality among very preterm neonates with pulmonary hypertension. JAMA Network Open. 2025;8:e2458843. https://doi.org/10.1001/jamanetworkopen.2024.58843. Su B-H, Lin H-Y, Huang F-K, Tsai M-L, Huang Y-T. Circulatory management focusing on preventing intraventricular hemorrhage and pulmonary hemorrhage in preterm infants. Pediatr Neonatol. 2016;57:453–62. https://doi.org/10.1016/j.pedneo.2016.01.001. Additional Declarations No competing interests reported. Supplementary Files TableS1S2S3.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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1","display":"","copyAsset":false,"role":"figure","size":304338,"visible":true,"origin":"","legend":"\u003cp\u003eFlow chart of study population\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8226064/v1/98f03061af58a051bcbc2fa9.jpeg"},{"id":97893987,"identity":"de2eb2f8-1d79-4d55-b1ab-5c404f7e3592","added_by":"auto","created_at":"2025-12-10 15:31:45","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":260687,"visible":true,"origin":"","legend":"\u003cp\u003eAssociation between VISmax scores and in-hospital mortality odds ratio. Solid and dashed lines represent the predicted value and 95% CI after adjusting for gestational age, Birth weight, gender, Delivery method, Prolonged rupture of membranes, Maternal hypertensive disease, Maternal diabetes, Antenatal steroids given, Suspected chorioamnionitis, Delivery Room Resuscitation, 1min Apgarscore, WBC, CRP, PLT, PCT.\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8226064/v1/9c04b153a4b82d28d48628d1.jpeg"},{"id":97893042,"identity":"c2d1b5fc-a5ce-4d8a-8104-aba486cb0103","added_by":"auto","created_at":"2025-12-10 15:26:13","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":275650,"visible":true,"origin":"","legend":"\u003cp\u003eForest plot of multivariable logistics analysis between VISmax scores and in-hospital mortality.\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-8226064/v1/0786903145c4c1f03a26dacc.png"},{"id":97893776,"identity":"dc1d2c25-acc0-469c-88f4-8d7a733cc5ba","added_by":"auto","created_at":"2025-12-10 15:31:11","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":63624,"visible":true,"origin":"","legend":"\u003cp\u003eKaplan-Meier analysis of in-hospital mortality according to VISmax group.\u003c/p\u003e","description":"","filename":"floatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-8226064/v1/033647801f3794ca8600aac8.png"},{"id":99312367,"identity":"e29afe28-fab7-489c-a383-25233f359b91","added_by":"auto","created_at":"2025-12-31 16:18:54","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2197908,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8226064/v1/d6b3836e-50f6-45db-afa0-571b5abcade5.pdf"},{"id":97688955,"identity":"bfef0961-84af-4cef-ba5e-cec1f1fe8faa","added_by":"auto","created_at":"2025-12-08 10:41:49","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":33270,"visible":true,"origin":"","legend":"","description":"","filename":"TableS1S2S3.docx","url":"https://assets-eu.researchsquare.com/files/rs-8226064/v1/9c13c443ffc779bf20fc93f8.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Association Between Vasoactive Inotropic Score and In-hospital Mortality in Preterm Neonates at \u003c34 Weeks Gestation with Early Pulmonary Hypertension: A Single-center Retrospective Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePulmonary hypertension (PH) in preterm infants exhibits unique characteristics due to the interconnections between alveolar and vascular immaturity[1]. The phenotype of early pulmonary hypertension in preterm infants is comprised of five types that include physiologic PH, PPHN, delayed PVT, early PH, and flow-associated PH[2]. Pulmonary hypertension is being increasingly recognized in infants born preterm and is associated with mortality, BPD, and longterm cardiorespiratory morbidity[3]. The prevalence of early PH in preterm infants is variable, ranging between 8% and 55% based on gestational age or birth weight cutoff chosen for prematurity and timing of echocardiography[4,5]. Early-onset PH occurs at birth or during the first weeks of life and may exhibit very different pathophysiologies with either increased pulmonary vascular resistance (PVR) such as observed in persistent neonatal PH (PPHN) or with postnatal decreased PVR such as observed in PH associated with increased pulmonary blood flow (PBF) due to left-to-right shunting through a patent ductus arteriosus (PDA)[6]. A recent meta-analysis to identify the risk factors associated with PH in preterm infants diagnosed within 2 weeks of life using clinical and echocardiographic criteria determined that oligohydramnios and small for gestational age (SGA) are strong predictors of early PH in preterm infants[7]. Systemic hypotension in early PH may be secondary to elevated PVR, increasing the RV afterload and decreasing PBF. This, in turn, leads to decreased LV preload[8]. Low systemic vascular resistance (SVR) and systemic hypotension requiring treatment are common in infants with PPHN. Two-thirds of infants with PPHN requiring ventilation and 87% of infants requiring ECMO are on 3 or more inotropes.[9] Several vasoactive medications may be useful to treat hypotension associated with PPHN in neonates. Indeed, the necessity and degree of hemodynamic support with vasoactive drugs is frequently considered as a marker of disease severity, and it is well established that mortality rates increase when high doses of vasoactive drugs are required[10]. The Vasoactive Inotropic score (VIS) has been used to measure illness severity in neonates and infants undergoing congenital heart surgery, septic pediatric patients admitted to the pediatric intensive care unit (PICU), or mortality in extremely premature (29 weeks completed gestation) and extremely low birth weight (ELBW, \u0026lt;\u0026thinsp;1000 g) infants[11\u0026ndash;13]. In these studies, the vasopressor dose load, VIS, and maximum VIS (VISmax) exhibited a direct relationship between the need for vasoactive-inotropic medications and the risk of morbidity and mortality. We aimed to determine the association between VISmax and the risk of mortality in Preterm Neonates at \u0026lt;\u0026thinsp;34 weeks of gestation with early pulmonary hypertension.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eData source and study population\u003c/h2\u003e\u003cp\u003eThis study was a retrospective cohort study. Preterm infants as \u0026lt;\u0026thinsp;34 weeks gestation with early pulmonary hypertension who had been admitted to the NICU of the Guangdong Women and Children Hospital between January 2021 to September 2024 were identified.Guangdong Women and Children Hospital is a Class Ⅲ Grade A hospital in Guangdong Province, China, with approximately 15,000 annual deliveries, 70% of which involve high-risk pregnancies. Its Department of Neonatology serves as one of the largest neonatal treatment centers in South China, admitting over 8,000 patients annually. The present study conformed to the principles of the Declaration of Helsinki. This study was approved by the Ethics Committee of Guangdong Women and Children's Hospital (202301194). Electronic medical records confirmed all clinical data, and two trained physicians collected the data. We collected information detailing maternal, neonatal, and vasoactive-inotropic medication exposure.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eDefinitions of early PH\u003c/h3\u003e\n\u003cp\u003eEarly onset PH was diagnosed in the first two weeks after birth and included PPHN, defined as the presence of a (predominantly) right-to-left shunt through an open foramen ovale (OFO) and/or PDA as determined by echocardiography and clinically by a preductal and postductal difference in transcutaneous oxygen saturation (tcSO2) of greater than 10%[14]. Flowassociated PH (flow PH) is defined as a nonrestrictive (Vmax\u0026thinsp;\u0026lt;\u0026thinsp;2.0 m/s) (predominantly) left-to-right shunt through a PDA, as revealed by echocardiography. [15] All echocardiograms were performed by certified sonographers. The images were then interpreted and diagnoses were made by neonatologists who integrated the echocardiographic findings with the clinical history.\u003c/p\u003e\n\u003ch3\u003eThe maximum vasoactive-inotropic score (VISmax)\u003c/h3\u003e\n\u003cp\u003eThe daily Vasoactive-Inotropic Score (VIS) was calculated for each neonate from birth until the end of the first week following the diagnosis of pulmonary hypertension (PH). The score was calculated using the formula: VIS\u0026thinsp;=\u0026thinsp;dopamine dose (\u0026micro;g/kg/min)\u0026thinsp;+\u0026thinsp;dobutamine dose (\u0026micro;g/kg/min)\u0026thinsp;+\u0026thinsp;100 \u0026times; epinephrine dose (\u0026micro;g/kg/min)\u0026thinsp;+\u0026thinsp;100 \u0026times; norepinephrine dose (\u0026micro;g/kg/min)\u0026thinsp;+\u0026thinsp;10 \u0026times; milrinone dose (\u0026micro;g/kg/min). The exposure variable of interest was the VISmax, defined as the highest single-day VIS score recorded during this period (from birth to one week post-PH diagnosis). This time window was chosen to capture the peak of hemodynamic instability associated with the diagnosis and initial management of PH. The exclusion criteria included the following: (1) suspected or confirmed chromosomal abnormality or other congenital malformations; (2) congenital heart disease requiring surgery; (3) congenital diaphragmatic hernia; (4) physiologic pulmonary hypertension and no need for invasive respiratory support; (5) medical records were incomplete. A detailed flow chart of subjects is shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\n\u003ch3\u003eCovariates\u003c/h3\u003e\n\u003cp\u003eAccording to the prior literature requirements, various potential covariates were assessed. Key demographic and clinical variables had no missing data. For covariates with missing data, such as white blood cell count(WBC) (missing 8.2%), platelet count(PLT) (missing 8.2%), Procalcitonin (PCT) (missing 8.2%), C-reactive protein (CRP)(missing 8.2%)(table S1-S2). The multiple imputation method utilized was a fully conditional specification (FCS) implemented by the MICE algorithm, as described by Van Buuren and Groothuis Oudshoorn (2011). The follow-up period for assessing all secondary clinical outcomes was defined as the duration from birth until the first occurrence of one of the following events: hospital discharge, death, or transfer to another tertiary care facility. Outcomes such as bronchopulmonary dysplasia (BPD) were assessed at 36 weeks' postmenstrual age (PMA) for infants who remained hospitalized at that time.\u003c/p\u003e\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eThis study aimed to observe the impact of the VISmax score on hospital mortality in preterm neonates born at \u0026lt;\u0026thinsp;34 weeks of gestation with early pulmonary hypertension. The patients were divided into three groups based on their VISmax scores (VIS1: VISmax\u0026thinsp;\u0026lt;\u0026thinsp;30, VIS2: 30\u0026thinsp;\u0026le;\u0026thinsp;VISmax\u0026thinsp;\u0026lt;\u0026thinsp;48, VIS3: 48\u0026thinsp;\u0026le;\u0026thinsp;VISmax)[12,16]. Descriptive analysis was applied to all patients. Continuous data are expressed as mean and standard deviation (SD) or median and interquartile range (IQR) (quartile 1-quartile 3 [interquartile range]), as appropriate. Categorical variables are expressed as proportions (%). Variables were compared using the chisquare test (categorical variables), one-way ANOVA (normal distribution), and Kruskal\u0026ndash;Wallis (skewed distribution). Multivariate logistic regression analysis was used to assess the independent association between VISmax scores and hospital mortality. It was the appropriate method for our binary primary outcome. Confounding factors were an important issue in the analysis, and we used different statistical models to verify the stability of the results. In the final model, we adjusted the factors based on the following rules. For the multivariate analysis, variables were chosen based on previous findings and clinical constraints. Survival curves were plotted using Kaplan-Meier and log-rank analyzes. Additionally, exploratory subgroup analyzes were performed based on gestational age, birth weight and gender. Statistical analyzes were conducted in R (version 4.2.1) (R Foundation for Statistical Computing) with the \"survey\" package (version 4.1-1) and Free Statistics software (version 1.9.25). A two-tailed p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was utilized to signify statistical significance in all analyzes.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\n \u003ch2\u003eStudy population and baseline characteristics\u003c/h2\u003e\n \u003cp\u003eOf the 238 preterm neonates born at \u0026lt;\u0026thinsp;34 weeks of gestation with early pulmonary hypertension, 55 died and 183 survived. The overall in-hospital mortality rate was 23.1%. Of the 175 patients with a VISmax\u0026thinsp;\u0026gt;\u0026thinsp;0, 45 experienced the VISmax within one calendar day of birth; all of them had the VISmax within 7 calendar days of birth. In this cohort, platelet levels at admission were skewed and distributed. Baseline characteristics of the study population according to survival states and VISmax scores are presented in Tables \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e and\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e. The gestational age and the birth weight of the survival group were 30.6\u0026thinsp;\u0026plusmn;\u0026thinsp;2.5 weeks and 1486.1\u0026thinsp;\u0026plusmn;\u0026thinsp;498.1 grams, while those of the mortality group were 28.4\u0026thinsp;\u0026plusmn;\u0026thinsp;2.8 weeks and 1094.7\u0026thinsp;\u0026plusmn;\u0026thinsp;399.9 grams. The mortality group exhibited lower PLT and lower WBC within 3 days after birth. In the mortality group, 47.3% of the infants received dexamethasone before delivery, and 70.9% received inhaled nitric oxide. In the VISmax score group, there were no significant differences in gestational age at birth and birth weight.\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eBaseline characteristics of the study participants.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTotal (n\u0026thinsp;=\u0026thinsp;238)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSurvival group (n\u0026thinsp;=\u0026thinsp;183)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eDeath group (n\u0026thinsp;=\u0026thinsp;55)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGA, Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30.1\u0026thinsp;\u0026plusmn;\u0026thinsp;2.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30.6\u0026thinsp;\u0026plusmn;\u0026thinsp;2.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28.4\u0026thinsp;\u0026plusmn;\u0026thinsp;2.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGAgroup, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGA\u0026thinsp;\u0026le;\u0026thinsp;28W\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e56 (23.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30 (16.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26 (47.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28\u0026thinsp;\u0026lt;\u0026thinsp;GA\u0026thinsp;\u0026le;\u0026thinsp;32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e110 (46.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e88 (48.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22 (40)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32\u0026thinsp;\u0026lt;\u0026thinsp;GA\u0026thinsp;\u0026le;\u0026thinsp;34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e72 (30.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e65 (35.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7 (12.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBW, Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1395.6\u0026thinsp;\u0026plusmn;\u0026thinsp;504.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1486.1\u0026thinsp;\u0026plusmn;\u0026thinsp;498.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1094.7\u0026thinsp;\u0026plusmn;\u0026thinsp;399.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBWgroup, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBW\u0026thinsp;\u0026le;\u0026thinsp;1000g\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50 (21.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26 (14.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24 (43.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1000\u0026thinsp;\u0026lt;\u0026thinsp;BW\u0026thinsp;\u0026le;\u0026thinsp;1500\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e97 (40.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e77 (42.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20 (36.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1500\u0026thinsp;\u0026lt;\u0026thinsp;BW\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e91 (38.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e80 (43.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11 (20)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGender, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003efemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e101 (42.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e77 (42.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24 (43.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003emale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e137 (57.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e106 (57.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e31 (56.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eApgar score, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eApgar score\u0026thinsp;\u0026lt;\u0026thinsp;8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e62 (26.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e36 (19.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26 (47.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8\u0026thinsp;\u0026le;\u0026thinsp;Apgar score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e176 (73.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e147 (80.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e29 (52.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDelivery method, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCesarean section\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e149 (62.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e124 (67.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25 (45.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003evaginal delivery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e89 (37.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e59 (32.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30 (54.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eProlonged rupture of membranes, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e188 (79.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e148 (80.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40 (72.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50 (21.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e35 (19.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15 (27.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIVF, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e201 (84.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e155 (84.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e46 (83.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e37 (15.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28 (15.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9 (16.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMaternal Hypertensive disease, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e196 (82.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e154 (84.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e42 (76.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e42 (17.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e29 (15.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13 (23.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMaternal diabetes, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e171 (71.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e128 (69.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e43 (78.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e67 (28.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e55 (30.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12 (21.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAntenatal steroids given, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e90 (37.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e61 (33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e29 (52.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e148 (62.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e122 (66.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26 (47.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSuspected chorioamnionitis, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e222 (93.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e170 (92.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e52 (94.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16 ( 6.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13 (7.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (5.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDelivery Room Resuscitation, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e221 (92.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e172 (94)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e49 (89.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17 ( 7.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11 (6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 (10.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWBC group, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWBC\u0026thinsp;\u0026le;\u0026thinsp;5\u0026times;10\u003csup\u003e9\u003c/sup\u003e/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e56 (23.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e36 (19.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20 (36.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u0026times;10\u003csup\u003e9\u003c/sup\u003e/L\u0026thinsp;\u0026lt;\u0026thinsp;WBC\u0026thinsp;\u0026le;\u0026thinsp;30\u0026times;10\u003csup\u003e9\u003c/sup\u003e/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e169 (71.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e138 (75.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e31 (56.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30\u0026times;10\u003csup\u003e9\u003c/sup\u003e/L\u0026thinsp;\u0026lt;\u0026thinsp;WBC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13 ( 5.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9 (4.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4 (7.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCRPgroup, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCRP\u0026thinsp;\u0026lt;\u0026thinsp;10 mg/l\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e158 (66.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e121 (66.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e37 (67.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10mg/l\u0026thinsp;\u0026lt;\u0026thinsp;CRP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e80 (33.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e62 (33.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18 (32.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePLTgroup, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePLT\u0026thinsp;\u0026lt;\u0026thinsp;100\u0026times;10\u003csup\u003e12\u003c/sup\u003e/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23 ( 9.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12 (6.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11 (20)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e100\u0026times;10\u003csup\u003e12\u003c/sup\u003e/L\u0026thinsp;\u0026lt;\u0026thinsp;PLT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e215 (90.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e171 (93.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e44 (80)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePCTgroup, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePCT\u0026thinsp;\u0026lt;\u0026thinsp;10ng/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e155 (65.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e118 (64.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e37 (67.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10ng/L\u0026thinsp;\u0026lt;\u0026thinsp;PCT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e83 (34.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e65 (35.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18 (32.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eiNO, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e146 (61.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e130 (71)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16 (29.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e92 (38.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e53 (29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39 (70.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSildenafil, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e218 (91.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e175 (95.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e43 (78.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20 ( 8.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8 (4.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12 (21.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ecorticosteroid use after iNO, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e198 (83.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e166 (90.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32 (58.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40 (16.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17 (9.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23 (41.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTreprostinil sodium, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e231 (97.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e182 (99.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e49 (89.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7 ( 2.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (0.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 (10.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVIS group(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVIS1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e170(71.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e145 (85.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25 (14.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVIS2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e31(13.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23 (74.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8 (25.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVIS3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e37(15.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15 (40.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22 (59.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003ePopulation characteristics categorized by VIS score.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" style=\"width: 38.1656%;\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" style=\"width: 15.0888%;\"\u003e\n \u003cp\u003eTotal (n\u0026thinsp;=\u0026thinsp;238)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVIS1 (n\u0026thinsp;=\u0026thinsp;170)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVIS2 (n\u0026thinsp;=\u0026thinsp;31)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVIS3 (n\u0026thinsp;=\u0026thinsp;37)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 38.1656%;\"\u003e\n \u003cp\u003eGA, Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.0888%;\"\u003e\n \u003cp\u003e30.1\u0026thinsp;\u0026plusmn;\u0026thinsp;2.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30.0\u0026thinsp;\u0026plusmn;\u0026thinsp;2.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30.1\u0026thinsp;\u0026plusmn;\u0026thinsp;3.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30.4\u0026thinsp;\u0026plusmn;\u0026thinsp;2.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 38.1656%;\"\u003e\n \u003cp\u003eGA group, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.0888%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 38.1656%;\"\u003e\n \u003cp\u003eGA\u0026thinsp;\u0026le;\u0026thinsp;28W\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.0888%;\"\u003e\n \u003cp\u003e56 (23.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e41 (24.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7 (22.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8 (21.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 38.1656%;\"\u003e\n \u003cp\u003e28\u0026thinsp;\u0026lt;\u0026thinsp;GA\u0026thinsp;\u0026le;\u0026thinsp;32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.0888%;\"\u003e\n \u003cp\u003e110 (46.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e78 (45.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14 (45.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18 (48.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 38.1656%;\"\u003e\n \u003cp\u003e32\u0026thinsp;\u0026lt;\u0026thinsp;GA\u0026thinsp;\u0026le;\u0026thinsp;34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.0888%;\"\u003e\n \u003cp\u003e72 (30.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51 (30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10 (32.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11 (29.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 38.1656%;\"\u003e\n \u003cp\u003eBW, Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.0888%;\"\u003e\n \u003cp\u003e1395.6\u0026thinsp;\u0026plusmn;\u0026thinsp;504.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1380.7\u0026thinsp;\u0026plusmn;\u0026thinsp;490.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1411.6\u0026thinsp;\u0026plusmn;\u0026thinsp;496.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1450.8\u0026thinsp;\u0026plusmn;\u0026thinsp;578.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 38.1656%;\"\u003e\n \u003cp\u003eBW group, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.0888%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 38.1656%;\"\u003e\n \u003cp\u003eBW\u0026thinsp;\u0026le;\u0026thinsp;1000g\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.0888%;\"\u003e\n \u003cp\u003e50 (21.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e36 (21.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 (19.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8 (21.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 38.1656%;\"\u003e\n \u003cp\u003e1000\u0026thinsp;\u0026lt;\u0026thinsp;BW\u0026thinsp;\u0026le;\u0026thinsp;1500\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.0888%;\"\u003e\n \u003cp\u003e97 (40.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e71 (41.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11 (35.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15 (40.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 38.1656%;\"\u003e\n \u003cp\u003e1500\u0026thinsp;\u0026lt;\u0026thinsp;BW\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.0888%;\"\u003e\n \u003cp\u003e91 (38.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e63 (37.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14 (45.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14 (37.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 38.1656%;\"\u003e\n \u003cp\u003eGender, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.0888%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 38.1656%;\"\u003e\n \u003cp\u003efemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.0888%;\"\u003e\n \u003cp\u003e101 (42.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e75 (44.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12 (38.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14 (37.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 38.1656%;\"\u003e\n \u003cp\u003emale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.0888%;\"\u003e\n \u003cp\u003e137 (57.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e95 (55.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19 (61.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23 (62.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 38.1656%;\"\u003e\n \u003cp\u003eApgar score, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.0888%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 38.1656%;\"\u003e\n \u003cp\u003eApgar score\u0026thinsp;\u0026lt;\u0026thinsp;8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.0888%;\"\u003e\n \u003cp\u003e62 (26.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39 (22.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10 (32.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13 (35.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 38.1656%;\"\u003e\n \u003cp\u003e8\u0026thinsp;\u0026le;\u0026thinsp;Apgar score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.0888%;\"\u003e\n \u003cp\u003e176 (73.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e131 (77.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21 (67.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24 (64.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 38.1656%;\"\u003e\n \u003cp\u003eDelivery method, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.0888%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 38.1656%;\"\u003e\n \u003cp\u003eCesarean section\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.0888%;\"\u003e\n \u003cp\u003e149 (62.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e102 (60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26 (83.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21 (56.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 38.1656%;\"\u003e\n \u003cp\u003evaginal delivery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.0888%;\"\u003e\n \u003cp\u003e89 (37.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e68 (40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 (16.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16 (43.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 38.1656%;\"\u003e\n \u003cp\u003eProlonged rupture of membranes, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.0888%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 38.1656%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.0888%;\"\u003e\n \u003cp\u003e188 (79.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e136 (80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22 (71)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30 (81.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 38.1656%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.0888%;\"\u003e\n \u003cp\u003e50 (21.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34 (20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9 (29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7 (18.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 38.1656%;\"\u003e\n \u003cp\u003eIVF, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.0888%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 38.1656%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.0888%;\"\u003e\n \u003cp\u003e201 (84.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e143 (84.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27 (87.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e31 (83.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 38.1656%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.0888%;\"\u003e\n \u003cp\u003e37 (15.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27 (15.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4 (12.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 (16.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 38.1656%;\"\u003e\n \u003cp\u003eMaternal hypertensive disease, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.0888%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 38.1656%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.0888%;\"\u003e\n \u003cp\u003e196 (82.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e137 (80.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28 (90.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e31 (83.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 38.1656%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.0888%;\"\u003e\n \u003cp\u003e42 (17.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e33 (19.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (9.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 (16.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 38.1656%;\"\u003e\n \u003cp\u003eMaternal diabetes, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.0888%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 38.1656%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.0888%;\"\u003e\n \u003cp\u003e171 (71.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e119 (70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23 (74.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e29 (78.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 38.1656%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.0888%;\"\u003e\n \u003cp\u003e67 (28.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51 (30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8 (25.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8 (21.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 38.1656%;\"\u003e\n \u003cp\u003eAntenatal steroids given, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.0888%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 38.1656%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.0888%;\"\u003e\n \u003cp\u003e90 (37.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e59 (34.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12 (38.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19 (51.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 38.1656%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.0888%;\"\u003e\n \u003cp\u003e148 (62.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e111 (65.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19 (61.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18 (48.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 38.1656%;\"\u003e\n \u003cp\u003eSuspected chorioamnionitis, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.0888%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 38.1656%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.0888%;\"\u003e\n \u003cp\u003e222 (93.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e158 (92.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28 (90.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e36 (97.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 38.1656%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.0888%;\"\u003e\n \u003cp\u003e16 ( 6.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12 (7.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (9.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (2.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 38.1656%;\"\u003e\n \u003cp\u003eDelivery Room Resuscitation, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.0888%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 38.1656%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.0888%;\"\u003e\n \u003cp\u003e221 (92.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e161 (94.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26 (83.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34 (91.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 38.1656%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.0888%;\"\u003e\n \u003cp\u003e17 ( 7.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9 (5.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 (16.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (8.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 38.1656%;\"\u003e\n \u003cp\u003eWBC group, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.0888%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 38.1656%;\"\u003e\n \u003cp\u003eWBC\u0026thinsp;\u0026le;\u0026thinsp;5\u0026times;10\u003csup\u003e9\u003c/sup\u003e/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.0888%;\"\u003e\n \u003cp\u003e56 (23.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e35 (20.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9 (29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12 (32.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 38.1656%;\"\u003e\n \u003cp\u003e5\u0026times;10\u003csup\u003e9\u003c/sup\u003e/L\u0026thinsp;\u0026lt;\u0026thinsp;WBC\u0026thinsp;\u0026le;\u0026thinsp;30\u0026times;10\u003csup\u003e9\u003c/sup\u003e/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.0888%;\"\u003e\n \u003cp\u003e169 (71.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e127 (74.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21 (67.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21 (56.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 38.1656%;\"\u003e\n \u003cp\u003e30\u0026times;10\u003csup\u003e9\u003c/sup\u003e/L\u0026thinsp;\u0026lt;\u0026thinsp;WBC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.0888%;\"\u003e\n \u003cp\u003e13 ( 5.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8 (4.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (3.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4 (10.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 38.1656%;\"\u003e\n \u003cp\u003eCRP group, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.0888%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 38.1656%;\"\u003e\n \u003cp\u003eCRP\u0026thinsp;\u0026lt;\u0026thinsp;10 mg/l\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.0888%;\"\u003e\n \u003cp\u003e135 (56.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e102 (60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13 (41.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20 (54.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 38.1656%;\"\u003e\n \u003cp\u003e10mg/l\u0026thinsp;\u0026lt;\u0026thinsp;CRP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.0888%;\"\u003e\n \u003cp\u003e103 (43.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e68 (40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18 (58.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17 (45.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 38.1656%;\"\u003e\n \u003cp\u003ePLT group, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.0888%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 38.1656%;\"\u003e\n \u003cp\u003ePLT\u0026thinsp;\u0026lt;\u0026thinsp;100\u0026times;10\u003csup\u003e12\u003c/sup\u003e/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.0888%;\"\u003e\n \u003cp\u003e23 ( 9.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15 (8.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (9.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 (13.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 38.1656%;\"\u003e\n \u003cp\u003e100\u0026times;10\u003csup\u003e12\u003c/sup\u003e/L\u0026thinsp;\u0026lt;\u0026thinsp;PLT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.0888%;\"\u003e\n \u003cp\u003e215 (90.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e155 (91.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28 (90.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32 (86.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 38.1656%;\"\u003e\n \u003cp\u003ePCT group, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.0888%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 38.1656%;\"\u003e\n \u003cp\u003ePCT\u0026thinsp;\u0026lt;\u0026thinsp;10ng/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.0888%;\"\u003e\n \u003cp\u003e155 (65.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e123 (72.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14 (45.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18 (48.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 38.1656%;\"\u003e\n \u003cp\u003e10ng/L\u0026thinsp;\u0026lt;\u0026thinsp;PCT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.0888%;\"\u003e\n \u003cp\u003e83 (34.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e47 (27.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17 (54.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19 (51.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 38.1656%;\"\u003e\n \u003cp\u003eiNO, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.0888%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 38.1656%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.0888%;\"\u003e\n \u003cp\u003e146 (61.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e131 (77.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13 (41.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (5.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 38.1656%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.0888%;\"\u003e\n \u003cp\u003e92 (38.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39 (22.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18 (58.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e35 (94.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 38.1656%;\"\u003e\n \u003cp\u003ecorticosteroid use, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.0888%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 38.1656%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.0888%;\"\u003e\n \u003cp\u003e198 (83.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e167 (98.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21 (67.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10 (27)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 38.1656%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.0888%;\"\u003e\n \u003cp\u003e40 (16.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (1.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10 (32.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27 (73)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 38.1656%;\"\u003e\n \u003cp\u003eTreprostinilsodium,n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.0888%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 38.1656%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.0888%;\"\u003e\n \u003cp\u003e231 (97.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e170 (100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e29 (93.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32 (86.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 38.1656%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.0888%;\"\u003e\n \u003cp\u003e7 ( 2.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (6.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 (13.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 38.1656%;\"\u003e\n \u003cp\u003eSildenafil, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.0888%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 38.1656%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.0888%;\"\u003e\n \u003cp\u003e218 (91.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e168 (98.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25 (80.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25 (67.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 38.1656%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.0888%;\"\u003e\n \u003cp\u003e20 ( 8.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (1.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 (19.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12 (32.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 38.1656%;\"\u003e\n \u003cp\u003eVIS, Median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.0888%;\"\u003e\n \u003cp\u003e10.0 (0.0, 30.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.0 (0.0, 12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e35.0(30.0, 40.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e63.0 (50.0, 90.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 38.1656%;\"\u003e\n \u003cp\u003estatement, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.0888%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 38.1656%;\"\u003e\n \u003cp\u003eSurvival group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.0888%;\"\u003e\n \u003cp\u003e183 (76.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e145 (85.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23 (74.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15 (40.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 38.1656%;\"\u003e\n \u003cp\u003edeath group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.0888%;\"\u003e\n \u003cp\u003e55 (23.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25 (14.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8 (25.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22 (59.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eRelationship between VISmax and in-hospital mortality\u003c/h3\u003e\n\u003cp\u003eIn the multivariate logistic regression analysis, the VISmax score was divided into three groups (VIS1: VISmax\u0026thinsp;\u0026lt;\u0026thinsp;30, VIS2: 30\u0026thinsp;\u0026le;\u0026thinsp;VISmax\u0026thinsp;\u0026lt;\u0026thinsp;48, and VIS3: 48\u0026thinsp;\u0026le;\u0026thinsp;VISmax), and after accounting for potential confounding factors, a significant positive correlation was observed between VISmax and death. In comparison to individuals in VIS1, the adjusted odds ratios (OR) for death were 2.39 (95% CI: 0.67\u0026ndash;8.57, p\u0026thinsp;=\u0026thinsp;0.181) in the second group (VIS2) and 10.6 (95% CI: 2.67\u0026ndash;42.13, p\u0026thinsp;=\u0026thinsp;0.001) in the third group (VIS3)(Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e).The spline analysis supported a linear association with the VISmax and hospital mortality within this population (p\u0026thinsp;=\u0026thinsp;0.431 for non-linearity, Fig. \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003cdiv align=\"char\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eAssociation between VISmax scores and in‑hospital mortality in multiple regression model.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eModel 1\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eModel 2\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eModel 3\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eModel 4\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eOR (95%CI)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eOR (95%CI)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eOR (95%CI)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eOR (95%CI)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTrend test\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.83 (1.93\u0026thinsp;~\u0026thinsp;4.16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.61 (2.3\u0026thinsp;~\u0026thinsp;5.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.63 (2.22\u0026thinsp;~\u0026thinsp;5.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.6 (2.14\u0026thinsp;~\u0026thinsp;6.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVIS1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1(Ref)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1(Ref)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1(Ref)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1(Ref)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVIS2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.02 (0.81\u0026thinsp;~\u0026thinsp;5.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.52 (0.91\u0026thinsp;~\u0026thinsp;6.93)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.008\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.07 (0.98\u0026thinsp;~\u0026thinsp;9.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.054\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.93 (0.9\u0026thinsp;~\u0026thinsp;9.49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.074\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVIS3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8.51 (3.89\u0026thinsp;~\u0026thinsp;18.59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13.83 (5.54\u0026thinsp;~\u0026thinsp;34.51)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13.5 (4.99\u0026thinsp;~\u0026thinsp;36.57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13.32 (4.64\u0026thinsp;~\u0026thinsp;38.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"9\"\u003eModel 1: no adjusted;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"9\"\u003eModel 2 was adjusted for gestational age, birth weight, gender;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"9\"\u003eModel 3 was adjusted for Model 2\u0026thinsp;+\u0026thinsp;Delivery method, Prolonged rupture of membranes, Maternal hypertensive disease, Maternal diabetes\u0026thinsp;+\u0026thinsp;Antenatal steroids given, Suspected chorioamnionitis\u0026thinsp;+\u0026thinsp;Delivery Room Resuscitation,1min Apgarscore;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"9\"\u003eModel 4 was adjusted for Model 3\u0026thinsp;+\u0026thinsp;WBC, CRP, PLT, PCT;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n \u003ch2\u003eStratified analyzes based on additional variables and survival analysis\u003c/h2\u003e\n \u003cp\u003eStratified analyzes of multiple subgroups revealed no significant interactions when stratified by BW, GA, gender.(Fig. \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e) Given the sample size, these subgroup analyzes should be interpreted with caution as exploratory findings to inform future research Fig. \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e depicts the Kaplan-Meier survival estimates for hospital mortality stratified by VISmax. Notably, the group with lower VISmax exhibited a higher survival rate in relation to early pulmonary hypertension. sensitivity analyzes were performed by excluding individuals with missing covariates. Similar results were obtained after adjusting the model for multivariate logistic and restricted cubic spline analyzes(table S3).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\n \u003ch2\u003eRelationship between VISmax and clinical outcomes\u003c/h2\u003e\n \u003cp\u003eThere was no significant difference in the incidence of BPD, NEC, ROP, PVL, and other adverse clinical outcomes among the three VIS groups of children after treatment, but there were significant differences in pulmonary hemorrhage, respiratory support, oxygen therapy, and length of hospital stay(Table \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e). The comparison of clinical outcomes in the survival group was performed separately to account for the potential for bias in complications in the presence of death(Table \u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e). The results indicated significant differences in pulmonary hemorrhage and duration of respiratory support (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab5\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eClinical outcomes categorized by VIS score.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTotal (n\u0026thinsp;=\u0026thinsp;238)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVIS1 (n\u0026thinsp;=\u0026thinsp;170)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVIS2 (n\u0026thinsp;=\u0026thinsp;31)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVIS3 (n\u0026thinsp;=\u0026thinsp;37)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003estatistic\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBPD, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.229\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.949\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e173 (72.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e119 (70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e23 (74.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e31 (83.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e65 (27.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51 (30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8 (25.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 (16.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNEC, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.506\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFisher\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e215 (90.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e152 (89.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e30 (96.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e33 (89.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e23 ( 9.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18 (10.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1 (3.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4 (10.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eROP, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.271\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFisher\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e232 (97.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e167 (98.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e30 (96.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e35 (94.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6 ( 2.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (1.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1 (3.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (5.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePulmonary hemorrhage, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFisher\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e211 (88.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e156 (91.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e28 (90.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27 (73)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e27 (11.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14 (8.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3 (9.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10 (27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGrade 3\u0026ndash;4 IVH or PVL, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.291\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFisher\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e205 (86.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e150 (88.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e25 (80.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30 (81.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e33 (13.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20 (11.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6 (19.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7 (18.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDuration of mechanical ventilation, Median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6.6 (3.7, 9.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.4 (3.8, 9.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8.0 (6.1, 9.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.7 (2.5, 8.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.118\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.268\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDuration of any airway pressure support, Median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13.5 (6.9, 29.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15.6 (7.6, 34.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13.5 (10.2, 22.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.4 (2.5, 11.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19.222\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDuration of oxygen therapy, Median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e17.8 (8.0, 49.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26.8 (10.6, 55.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e15.6 (10.2, 47.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.4 (2.5, 13.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25.034\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDuration of hospitalization, Median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e35.9 (17.0, 61.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e42.5 (22.0, 67.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e36.8 (14.7, 58.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.8 (2.6, 28.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28.654\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003ctable id=\"Tab6\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eClinical outcomes categorized by VIS score in survival group.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTotal (n\u0026thinsp;=\u0026thinsp;183)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVIS1 (n\u0026thinsp;=\u0026thinsp;145)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVIS2 (n\u0026thinsp;=\u0026thinsp;23)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVIS3 (n\u0026thinsp;=\u0026thinsp;15)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003estatistic\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBPD, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.308\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e122 (66.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e95 (65.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15 (65.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12 (80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e61 (33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e50 (34.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8 (34.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNEC, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.499\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFisher\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e168 (91.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e131 (90.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22 (95.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15 (100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e15 ( 8.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e14 (9.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (4.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eROP, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.072\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFisher\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e177 (96.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e142 (97.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22 (95.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13 (86.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6 ( 3.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3 (2.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (4.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (13.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGrade 3 4 IVH or PVL, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.903\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFisher\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e164 (89.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e130 (89.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20 (87)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14 (93.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e19 (10.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e15 (10.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (6.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePulmonary hemorrhage, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.009\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFisher\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e172 (94.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e139 (95.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22 (95.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11 (73.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e11 ( 6.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6 (4.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (4.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4 (26.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDuration of mechanical ventilation, Median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7.1 (4.3, 9.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6.5 (4.0, 9.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8.1 (7.0, 10.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.9 (6.3, 10.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.024\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.439\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDuration of any airway pressure support, Median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e17.4 (10.8, 34.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e18.6 (10.1, 36.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19.3 (12.7, 26.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11.0 (10.4, 18.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.189\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.336\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDuration of oxygen therapy, Median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e31.6 (12.1, 55.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e33.7 (13.2, 61.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34.4 (13.2, 52.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12.2 (10.8, 29.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.811\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDuration of hospitalization, Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e49.9\u0026thinsp;\u0026plusmn;\u0026thinsp;25.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e51.1\u0026thinsp;\u0026plusmn;\u0026thinsp;25.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51.6\u0026thinsp;\u0026plusmn;\u0026thinsp;29.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e35.4\u0026thinsp;\u0026plusmn;\u0026thinsp;21.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.073\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.651\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003ePrevious studies have predominantly focused on BPD related to pulmonary hypertension\u003c/p\u003e\u003cp\u003eand have paid little attention to the systemic hypotension associated with pulmonary\u003c/p\u003e\u003cp\u003ehypertension and the resulting hospital mortality rate. Our study is an essential initial, exploratory investigation into investigating the impact of VISmax scores on in-hospital mortality in preterm infants with pulmonary hypertension before 34 weeks of gestation. This retrospective study yielded the following findings: (1) A VISmax level of higher than 48 was associated with an increased risk of death, and VISmax was positively correlated with the mortality rate in preterm infants with pulmonary hypertension before 34 weeks; (2) Among survivors, a higher VIS score was associated with an increased incidence of pulmonary hemorrhage, longer duration of mechanical ventilation, prolonged oxygen dependency, and extended hospital stay.\u003c/p\u003e\u003cp\u003eRecent epidemiological and physiological studies have demonstrated an even greater incidence of PPHN in preterm infants than in newborns delivered at term, and this is strongly associated with prematurity severity and a 3.5-fold increase in mortality[17,18]. When children with pulmonary hypertension develop hypoxemia accompanied by systemic hypotension, vasopressors are typically used for blood pressure management. However, different vasoactive drugs exert varying effects on pulmonary artery pressure[19\u0026ndash;21]. Clinicians may have different choices of vasoactive drugs when dealing with patients of different phenotypes of pulmonary arterial hypertension. The VISmax was an easily quantifiable measure of vasoactive-inotropic support. The direct association between VISmax and death risk in our PH premature cohort was similar to that of other studies examining children and adults. Gaies et al. reported that a VISmax of 20\u0026ndash;24 in the first 24 hours or a VISmax of 15\u0026ndash;19 in the subsequent 48 hours post congenital heart surgery in infants was associated with a higher risk of death (in-hospital or within 30 days of discharge), cardiac arrest, need for mechanical circulatory support, need for renal replacement therapy, or central nervous system injury relative to the \"low risk\" group (VISmax\u0026thinsp;\u0026lt;\u0026thinsp;3)[22]. Among pediatric patients with sepsis admitted to the PICU, Haque et-al. observed that a VISmax\u0026thinsp;\u0026gt;\u0026thinsp;20 was associated with 100% mortality[23]. Our study determined that VISmax was positively correlated with mortality in PH of preterm infants at \u0026lt;\u0026thinsp;34 gestation. This study also demonstrated that VISmax were related to increased mortality after adjusting for various potential covariates. Smooth line analysis of the generalized additive model revealed a linear relationship between VISmax and mortality.\u003c/p\u003e\u003cp\u003eOur subgroup analysis showed no interaction between VISmax and death across subgroups, and survival analysis indicated that the group with lower VISmax scores exhibited a higher survival rate. The initial period following PH diagnosis is often the most unstable, representing the severity of the underlying cardiorespiratory illness.A multicenter prospective observational cohort study revealed that the median age at iNO initiation was on day 1 of life in very preterm neonates with pulmonary hypertension.In the early acute pulmonary hypertension group, mortality was associated with lower GA and birth weight, less use of antenatal corticosteroids, higher incidence of prolonged rupture of membranes and increased pre-iNO vasoactive drug use.[24] This study focuses more specifically than prior literature on the therapeutic demand for vasoactive agents in addressing systemic perfusion hypotension subsequent to pulmonary hypertension (PH).Of note, there is no unified standard for the maximum dosage of combining different vasoactive drugs. We still do not possess a clear understanding of the limit.\u003c/p\u003e\u003cp\u003eFurthermore, in the analysis of clinical outcomes, we observed a higher incidence of pulmonary hemorrhage in the group receiving higher doses of vasoactive medications. We hypothesize that this phenomenon is related to the pathophysiological alterations in pulmonary hypertension: in severe cases, the reduction of pulmonary arterial pressure concurrently leads to changes in shunt direction through the ductus arteriosus, thereby increasing left ventricular preload. This results in elevated pulmonary venous pressure and venous congestion, ultimately contributing to pulmonary hemorrhage. Paradoxically, the administration of excessive vasoactive drugs may potentially exacerbate this phenomenon[25].Fortunately, the widespread application of bedside critical ultrasound for premature infants may provide significant assistance for guiding the use of vasoactive drugs for these patients. In future studies, the use of vasoactive drugs in these patients will become more refined, and the survival rate will increase.\u003c/p\u003e\u003cp\u003eThis study possesses several important limitations. First, its single-center, retrospective design inherently limits the generalizability of our findings and introduces potential for selection and observer bias. While we employed strict, pre-defined criteria for patient inclusion and echocardiographic diagnosis, practice patterns and patient populations at other centers may yield different results. Our findings should be considered hypothesis-generating and require validation in larger, prospective, multi-center studies. Second, while we addressed missing data using multiple imputation and demonstrated the robustness of our primary result through sensitivity analysis, the possibility that data were not missing at random cannot be entirely excluded. This remains a limitation inherent to observational data. Third, we conducted exploratory subgroup analyzes to assess the consistency of the association between VISmax and in-hospital mortality across key patient characteristics. Although no significant interactions were found (all interaction p-values\u0026thinsp;\u0026gt;\u0026thinsp;0.10), the direction of the hazard ratio was consistent in subgroups defined by gestational age, birth weight, and gender. This finding requires confirmation in larger, dedicated cohorts. Although we used the highest VIS value over a specified period, the relationship between the timing of VISmax occurrence and clinical outcomes in this population presents a compelling area for further investigation. We were unable to determine the temporal association between VISmax and PH mortality. This question would require a larger dataset and sample size for robust analysis. Further prospective studies are required to confirm our findings.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe findings of this retrospective cohort study suggest that VISmax is positively associated with mortality rate in preterm infants with pulmonary hypertension at \u0026lt;\u0026thinsp;34 weeks of age.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eStatement of Ethics\u003c/h2\u003e\u003cp\u003e The studies were reviewed and approved by the Medical Ethics Committee of Guangdong Women and Children Hospital.The ethics committee waived the requirement of written informed consent for participation.\u003c/p\u003e\u003ch2\u003eConflict of Interest Statement\u003c/h2\u003e\u003cp\u003eThe authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.The authors have no conflicts of interest to declare.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding Sources\u003c/h2\u003e\u003cp\u003eThis project was supported by Guangdong Basic and Applied Basic Research Foundation(No:2025A1515012722, 2023A1515010674),Guangzhou Science and Technology Project༈No:2025A03J4281, 2024B03J1297༉\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eDZ conducted the data collection and analysis. YL wrote the manuscript. GWW and DZ modified the manuscript. CXF conducted the data interpretation. ZD drew the figure. YL and XGL conducted the data collection. CXF made the table. NC designed the study and reviewed the manuscript. All authors contributed to the article and approved the submitted version.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eWe thank all patients and staff who agreed to participate in this study. We sincerely thank the reviewers of this article. Their valuable suggestions have substantially helped to improve this article.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe raw data required to reproduce these findings cannot be shared at this time as the data also form part of an ongoing study. If necessary, some or all data generated or used during the study are available from the corresponding author by request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eAbman SH, Hansmann G, Archer SL, Ivy DD, Adatia I, Chung WK, et al. Pediatric pulmonary hypertension: guidelines from the american heart association and american thoracic society. Circulation. 2015 Nov;132(21):2037\u0026ndash;99.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eMani S, Mirza H, Ziegler J, Chandrasekharan P. Early Pulmonary Hypertension in Preterm Infants. Clinics in Perinatology. 2023 Dec;S0095510823001100.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eCollaco JM, Romer LH, Stuart BD, Coulson JD, Everett AD, Lawson EE, et al. Frontiers in Pulmonary Hypertension in Infants and Children With Bronchopulmonary Dysplasia. Pediatr Pulmonol. 2012 Nov;47(11):1042\u0026ndash;53.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eArjaans S, Fries MWF, Schoots MH, Schilte CFM, Roofthooft MTR, Vrijlandt EJLE, et al. Clinical significance of early pulmonary hypertension in preterm infants. J Pediatr. 2022 Dec;251:74-81.e3.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eAbman SH. The 13th Bengt Robertson Memorial Lecture: Pulmonary Hypertension: the Hidden Danger for Newborns. Neonatology. 2021;118(2):211\u0026ndash;7.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eArjaans S, Zwart ElviraAH, Roofthooft M, Kooi EMW, Bos AF, Berger RMF. Pulmonary hypertension in extremely preterm infants: a call to standardize echocardiographic screening and follow-up policy. Eur J Pediatr. 2021 Jun;180(6):1855\u0026ndash;65.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eStorme L, Aubry E, Rakza T, Houeijeh A, Debarge V, Tourneux P, et al. Pathophysiology of persistent pulmonary hypertension of the newborn: impact of the perinatal environment. Archives of Cardiovascular Diseases. 2013 Mar;106(3):169\u0026ndash;77.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eSiefkes HM, Lakshminrusimha S. Management of systemic hypotension in term infants with persistent pulmonary hypertension of the newborn (PPHN) \u0026ndash; an illustrated review. Arch Dis Child Fetal Neonatal Ed. 2021 Jul;106(4):446\u0026ndash;55.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eMydam J, Zidan M, Chouthai NS. A comprehensive study of clinical biomarkers, use of inotropic medications and fluid resuscitation in newborns with persistent pulmonary hypertension. Pediatr Cardiol. 2015 Jan;36(1):233\u0026ndash;9.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eBelletti A, Lerose CC, Zangrillo A, Landoni G. Vasoactive-inotropic score: evolution, clinical utility, and pitfalls. Journal of Cardiothoracic and Vascular Anesthesia. 2021 Oct;35(10):3067\u0026ndash;77.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eBrand DA, Patrick PA, Berger JT, Ibrahim M, Matela A, Upadhyay S, et al. Intensity of Vasopressor Therapy for Septic Shock and the Risk of In-Hospital Death. Journal of Pain and Symptom Management. 2017 May;53(5):938\u0026ndash;43.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eAziz KB, Lavilla OC, Wynn JL, Lure AC, Gipson D, de la Cruz D. Maximum vasoactive-inotropic score and mortality in extremely premature, extremely low birth weight infants. J Perinatol : Off J Calif Perinat Assoc. 2021 Sep;41(9):2337\u0026ndash;44.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eButts RJ, Scheurer MA, Atz AM, Zyblewski SC, Hulsey TC, Bradley SM, et al. Comparison of maximum vasoactive inotropic score and low cardiac output syndrome As markers of early postoperative outcomes after neonatal cardiac surgery. Pediatr Cardiol. 2012 Apr;33(4):633\u0026ndash;8.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eLakshminrusimha S, Keszler M. Persistent pulmonary hypertension of the newborn. Neoreviews. 2015 Dec;16(12):e680\u0026ndash;92.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eLai GY, Shlobin N, Garcia RM, Wescott A, Kulkarni AV, Drake J, et al. Global incidence proportion of intraventricular haemorrhage of prematurity: a meta-analysis of studies published 2010\u0026ndash;2020. Arch Dis Child - Fetal Neonatal Ed. 2022 Sep;107(5):513\u0026ndash;9.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eKoponen T, Karttunen J, Musialowicz T, Pietil\u0026auml;inen L, Uusaro A, Lahtinen P. Vasoactive-inotropic score and the prediction of morbidity and mortality after cardiac surgery. Br J Anaesth. 2019 Apr;122(4):428\u0026ndash;36.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eNakanishi H, Suenaga H, Uchiyama A, Kusuda S. Persistent pulmonary hypertension of the newborn in extremely preterm infants: a Japanese cohort study. Arch Dis Child - Fetal Neonatal Ed. 2018 Nov;103(6):F554\u0026ndash;61.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eMorbidity of persistent pulmonary hypertension of the newborn in the first year of life - PubMed [Internet]. [cited 2025 May 30]. Available from: https://pubmed.ncbi.nlm.nih.gov/31399244/\u003c/li\u003e\n \u003cli\u003eLiet J-M, Boscher C, Gras-Leguen C, Gournay V, Debillon T, Roz\u0026eacute; J-C. Dopamine effects on pulmonary artery pressure in hypotensive preterm infants with patent ductus arteriosus. J Pediatr. 2002 Mar;140(3):373\u0026ndash;5.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eJaillard S, Elbaz F, Bresson-Just S, Riou Y, Houfflin-Debarge V, Rakza T, et al. Pulmonary vasodilator effects of norepinephrine during the development of chronic pulmonary hypertension in neonatal lambs. Br J Anaesth. 2004 Dec;93(6):818\u0026ndash;24.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eTourneux P, Rakza T, Bouissou A, Krim G, Storme L. Pulmonary circulatory effects of norepinephrine in newborn infants with persistent pulmonary hypertension. J Pediatr. 2008 Sep;153(3):345\u0026ndash;9.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eGaies MG, Gurney JG, Yen AH, Napoli ML, Gajarski RJ, Ohye RG, et al. Vasoactive\u0026ndash;inotropic score as a predictor of morbidity and mortality in infants after cardiopulmonary bypass*: Pediatr Crit Care Med. 2010 Mar;11(2):234\u0026ndash;8.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eHaque A, Siddiqui NR, Munir O, Saleem S, Mian A. Association between vasoactive-inotropic score and mortality in pediatric septic shock. Indian Pediatr. 2015 Apr;52(4):311\u0026ndash;3.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eBaczynski M, Weisz D, Thomas L, Fevrier S, Castaldo M, Soraisham A, et al. Response to inhaled nitric oxide and mortality among very preterm neonates with pulmonary hypertension. JAMA Network Open. 2025;8:e2458843. https://doi.org/10.1001/jamanetworkopen.2024.58843.\u003c/li\u003e\n \u003cli\u003eSu B-H, Lin H-Y, Huang F-K, Tsai M-L, Huang Y-T. Circulatory management focusing on preventing intraventricular hemorrhage and pulmonary hemorrhage in preterm infants. Pediatr Neonatol. 2016;57:453\u0026ndash;62. https://doi.org/10.1016/j.pedneo.2016.01.001.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Vasoactive Inotropic Score, Mortality, Preterm, Pulmonary Hypertension","lastPublishedDoi":"10.21203/rs.3.rs-8226064/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8226064/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe relationship between vasoactive-inotropic score (VIS) and in-hospital mortality in Preterm Neonates at \u0026lt;34 Weeks Gestation with Early Pulmonary Hypertension remains unclear. We aimed to clarify this relationship in preterm neonates born at \u0026lt;34 weeks of gestation with early pulmonary hypertension.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA retrospective study was conducted on preterm infants (gestational age \u0026lt;34 weeks) with neonatal pulmonary hypertension who were hospitalized in the Department of Neonatology at Guangdong Women and Children's Hospital between January 2021 and September 2024. Multivariable logistic regression, restricted cubic spline, and subgroup analyzes were employed, adjusting for potential confounders.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 238 preterm infants with early pulmonary hypertension at \u0026lt;34 weeks of gestation were included. After adjusting for potential confounding factors, compared with individuals in the lowest VISmax group (VISmax\u0026lt;30), the adjusted odds ratio (OR) for in-hospital mortality was 2.93 (95% CI: 0.9-9.49, p =0.074) in the second group (30≤VISmax\u0026lt;48) and 13.32 (95% CI: 4.64-38.2, p \u0026lt; 0.001) in the third group (48≤VISmax). Furthermore, a linear relationship was observed between VISmax and in-hospital mortality (p = 0.431), with subgroup and sensitivity analyzes confirming the stability of the results. The subgroup analysis did not reveal any significant interaction between VISmax and in-hospital mortality.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe findings of this retrospective cohort study suggest that VISmax is positively associated with mortality rate in preterm infants with early pulmonary hypertension at \u0026lt;34 weeks.\u003c/p\u003e","manuscriptTitle":"Association Between Vasoactive Inotropic Score and In-hospital Mortality in Preterm Neonates at \u0026lt;34 Weeks Gestation with Early Pulmonary Hypertension: A Single-center Retrospective Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-08 10:41:45","doi":"10.21203/rs.3.rs-8226064/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"11a87297-5d38-477a-bc60-67729d4358e8","owner":[],"postedDate":"December 8th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-12-25T07:09:09+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-08 10:41:45","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8226064","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8226064","identity":"rs-8226064","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}