{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T00:56:36Z","timestamp":1792803396725,"version":"4.5.0"},"reference-count":31,"publisher":"American Medical Association (AMA)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Evaluation and treatment of transitional circulation in neonates with extremely low gestational age (ELGA) varies greatly across centers.<\/jats:p><\/jats:sec>Objective<\/jats:title>To determine whether multimodal hemodynamic monitoring in neonates with ELGA during the transitional period (first 72 hours of life) will improve cardiorespiratory-kidney health by decreasing vasoactive-ventilation-renal (VVR) score at 7 days.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This unmasked, 2-arm randomized clinical trial included neonates born at a gestational age of 230<\/jats:sup> to 286<\/jats:sup> weeks and admitted to a neonatal unit in Canada. Patients were enrolled from February 15, 2019, to December 31, 2021, with follow-up completed in April 2022.<\/jats:p><\/jats:sec>Interventions<\/jats:title>Neonates in the multimodal arm received early targeted neonatal echocardiography at 18 to 24 and 66 to 72 hours of life and cerebral near-infrared spectroscopy (NIRS) for the first 72 hours. A study guideline incorporating clinical-biochemical and cerebral near-infrared spectroscopy data was used for hemodynamic consultation in the multimodal arm. Neonates in the standard arm received hemodynamic assessment using clinical-biochemical data.<\/jats:p><\/jats:sec>Main Outcome and Measures<\/jats:title>The primary outcome was VVR score at 7 days. The VVR score incorporates measures of inotrope use, ventilation support, and kidney function to reflect cardiorespiratory-kidney health, with possible scores ranging from 0 to 69.62 at 7 days; higher scores indicate worse cardiorespiratory-kidney health.<\/jats:p><\/jats:sec>Results<\/jats:title>Primary analysis included 132 neonates with ELGA (68 in the multimodal arm and 64 in the standard arm) with mean (SD) gestational age of 26.4 (1.5) weeks (75 [56.8%] male). The mean (SD) VVR score at 7 days was 16.5 (15.4) in the multimodal arm and 18.9 (20.2) in the standard arm (P<\/jats:italic>\u2009=\u2009.45). A day 7 peak VVR score greater than 53 (&amp;gt;95th percentile for VVR in the entire cohort) was seen only in the standard arm (7 of 63 [11.1%] vs 0 in the multimodal arm; P<\/jats:italic>\u2009=\u2009.005) and was associated with a composite outcome of death or severe intraventricular hemorrhage (odds ratio [OR], 12.37; 95% CI, 1.92-79.63; P<\/jats:italic>\u2009=\u2009.001) and bronchopulmonary dysplasia (BPD) (6 of 6 [100%] vs 55 of 116 [47.4%]; P<\/jats:italic>\u2009=\u2009.01). Incidence of BPD was lower in the multimodal arm (26 of 63 [41.3%] vs 36 of 61 [59.0%]; P<\/jats:italic>\u2009=\u2009.04). Logistic regression showed that VVR score at 7 days in the top quartile (adjusted OR [AOR], 11.40; 95% CI, 2.04-63.67), late sepsis (AOR, 65.24; 95% CI, 5.70-748.18), and patent ductus arteriosus treatment after 72 hours of life vs early or no treatment needed (AOR, 7.20; 95% CI, 1.60-32.41) were associated with BPD.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>In this study of neonates with ELGA, multimodal hemodynamic assessment was not associated with decreased VVR scores at 7 days. However, this approach led to lower incidence of VVR associated with severe adverse outcomes and lower BPD incidence, suggesting further investigation is needed.<\/jats:p><\/jats:sec>Trial Registration<\/jats:title>ClinicalTrials.gov Identifier: NCT03841929<\/jats:ext-link><\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.4101","type":"journal-article","created":{"date-parts":[[2025,4,9]],"date-time":"2025-04-09T15:00:39Z","timestamp":1744210839000},"page":"e254101","source":"Crossref","is-referenced-by-count":9,"title":["Multimodal Monitoring of Hemodynamics in Neonates With Extremely Low Gestational Age"],"prefix":"10.1001","volume":"8","author":[{"given":"Renjini","family":"Lalitha","sequence":"first","affiliation":[{"name":"Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Western Ontario, London, Canada"},{"name":"Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Alberta, Edmonton, 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