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  • Clinical Research Article
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PDA management strategies and pulmonary hypertension in extreme preterm infants with bronchopulmonary dysplasia

Pediatric Research (2024)Cite this article

Abstract

Background

Premature infants are at risk for developing pulmonary hypertension (PH) in the context of bronchopulmonary dysplasia (BPD). Studies suggest a potential link between prolonged patent ductus arteriosus (PDA) exposure and BPD-PH, though management strategies remain controversial.

Methods

Retrospective echocardiographic evaluation of newborns <29 weeks gestational age with BPD at two distinct centers. Primary objective was to evaluate the relationship between center-specific PDA management strategies (interventional or conservative) and the prevalence of BPD-PH. BPD was defined as oxygen or respiratory support at 36 weeks post-menstrual age (PMA). The presence of PH was defined as either an estimated sPAP of ≥40 mmHg or sEI ≥1.3. Center A has a conservative PDA policy. Center B has a targeted interventional policy.

Results

PH rates were similar between sites (21% vs 17%), while rates of PDA treatment was different (7% vs 81). Adjusted models did not demonstrate an association for center or PDA treatment exposure for PH and EI, although infants from Center A had echocardiography evidence of higher systolic eccentricity index (EI; 1.12 ± 0.19 vs 1.06 ± 0.15, p = 0.04). Markers of RV function (TAPSE and RV-FAC) were similar between groups.

Conclusion

In preterm infants <29 weeks with BPD, conservative PDA treatment policy was not associated with higher rate of pulmonary hypertension diagnosis.

Impact

  • The association between PDA-management approaches and the occurrence of BPD-associated pulmonary vascular disease in premature infants has sparsely been described.

  • We found that a conservative policy, regarding the PDA, was not associated with an increase in pulmonary hypertension diagnosis.

  • We identified that, in patients with BPD, echocardiographic metrics of LV performance were lower.

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Data availability

The datasets generated during and/or analysed during the current study are available from corresponding author on reasonable request.

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Acknowledgements

We acknowledge the support of the Canadian Neonatal Network who provided the local CHUL and MUHC database with the standardized definitions. We would like to acknowledge the work done by Mr Narcisse Singbo and his support regarding some of the preliminary statistical analysis.

Funding

This NeoCardioLab and its platforms were funded by the Department of Pediatrics of McGill University, the Just for Kids Foundation, the Foundation of Stars, as well as the Grand Defi Pierre Lavoie. Funding for statistical support was provided from Center de recherche clinique CHU de Québec.

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Authors and Affiliations

  1. Division of Neonatology, CHU de Québec, Université Laval, Quebec City, QC, Canada

    Audrey Hébert, Camille Maltais-Bilodeau, Marie-Ève Leclerc & Christine Drolet

  2. Division of Neonatology, University of Iowa Children’s Hospital, University of Iowa, Iowa city, IA, USA

    Patrick J. McNamara

  3. Division of Neonatology, McGill University Health Centre, McGill University, Montreal, QC, Canada

    Gabriela De Carvalho Nunes, Punnanee Wutthigate, Jessica Simoneau & Gabriel Altit

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Contributions

AH conceptualized and designed the study, collected the data, analyzed the data, drafted the manuscript, and adjusted the manuscript according to the comments of the co-authors. GN, CMB, MEL, JS and PW collected the data, critically appraised the analysis and revised the manuscript. CD critically appraised the analysis of the data and reviewed and revised the manuscript. PM critically appraised the analysis of the data and reviewed and revised the manuscript. GA conceptualized and designed the study, supervised data collection, critically appraised the analysis of the data, wrote, and critically reviewed the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

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Correspondence to Audrey Hébert.

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Hébert, A., McNamara, P.J., Carvalho Nunes, G.D. et al. PDA management strategies and pulmonary hypertension in extreme preterm infants with bronchopulmonary dysplasia. Pediatr Res (2024). https://doi.org/10.1038/s41390-024-03321-1

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