Regan E Giesinger, Danielle R Rios, Trassanee Chatmethakul, Adrianne R Bischoff, Jeremy A Sandgren, Alison Cunningham, Madeline Beauchene, Amy H Stanford, Jonathan M Klein, Patrick Ten Eyck, Patrick J McNamara

Increasing survival of extremely preterm infants with a stable rate of severe intraventricular hemorrhage represents a growing health risk for neonates. To evaluate the role of early hemodynamic screening on the risk of death/severe intraventricular hemorrhage. All eligible patients 22-26+6 weeks gestation born/admitted <24h postnatal age were included. As compared to standard neonatal care for controls (01/2010-12/2017), patients admitted in the second epoch (10/2018-04-2022) were exposed to hemodynamic screening (HS) using targeted neonatal echocardiography at 12-18h. A primary composite outcome of death/severe intraventricular hemorrhage was decided a priori using a 10% reduction in baseline rate to calculate sample size. A total of n=423 controls and n=191 screening patients were recruited with a mean gestation and birthweight of 24.71.5 weeks and 699191 grams respectively; infants born at 22-23 weeks represented 44% (n=84) of the HS epoch vs 32% (n=135) of the controls (p=0.004). Increase in perinatal optimization (e.g., antepartum steroids) but with a decline in maternal health (e.g., increased obesity) were seen in HS vs control epoch. A reduction in the primary outcome, and each of severe intraventricular hemorrhage, death, death in the first postnatal week, necrotizing enterocolitis, and severe bronchopulmonary dysplasia were seen in the screening era. After adjustment for perinatal confounders and time, screening was independently associated with survival free of severe intraventricular hemorrhage with an odds ratio of 2.09 [1.19, 3.66]. Early hemodynamic screening and physiology-guided care may be an avenue to further improve neonatal outcomes; further evaluation is warranted.