Hemodynamically significant PDA impacts adverse outcomes in infants with BPD: a multicenter study.

backgroundBronchopulmonary dysplasia (BPD) and significant hemodynamic patent ductus arteriosus (hsPDA) are both common and important clinical issues in extremely preterm infants. The potential impact on prognosis when these conditions coexist is a major focus of clinical concern. This study examined the relationship between hsPDA and adverse outcomes in BPD infants.

methodsA retrospective analysis of 781 preterm infants (<32 weeks) from three hospitals (2018-2023). Based on echocardiographic assessment, infants were categorized as the non-PDA group, the non-hsPDA group, or the hsPDA group. Further subgroups were formed according to treatment and ductus arteriosus size (<1.5 mm, 1.5-3 mm, ≥3 mm). The effects of hsPDA on short-term outcomes in infants with BPD were assessed using logistic regression and linear regression.

resultsThe study included 781 infants (548 non-BPD, 233 BPD). The hsPDA subgroup had lower gestational age, higher birth asphyxia rates, and required more invasive respiratory support. In BPD infants, hsPDA was linked to longer respiratory support, higher pneumonia and feeding intolerance risks, prolonged oxygen therapy, and PH. Infants with hsPDA had longer hospital stays and oxygen therapy. Intervention therapy in infants with hsPDA was associated with prolonged oxygen therapy duration, reduced feeding intolerance, and increased risk of pulmonary hypertension（PH）. Meanwhile, ductus arteriosus diameter >3 mm was linked to elevated risks of feeding intolerance, pulmonary hypertension, and extrauterine growth restriction. After adjusting for gestational age and birth weight, results from multivariate logistic regression and multiple linear regression analyses indicated that hsPDA was independently associated with increased risk of neonatal PH (aOR = 7.502, 95% CI: 4.046-13.911, P < 0.001) and significantly prolonged invasive respiratory support duration (β = 6.530 days, 95% CI: 1.691-11.368, P = 0.008).

conclusionIn BPD infants, hsPDA is associated with the occurrence of PH and longer duration of invasive respiratory support. IMPACT: This study highlights the significant correlation between hemodynamically significant patent ductus arteriosus (hsPDA) and adverse outcomes in infants diagnosed with bronchopulmonary dysplasia (BPD), providing valuable clinical evidence for better management strategies. This study adds to the literature by showing that in very preterm infants with BPD, the presence of hsPDA was independently correlated with both an increased risk of pulmonary hypertension and a longer duration of invasive respiratory support.