Rationale: Hemodynamically significant patent ductus arteriosus (hsPDA) in premature infants has been associated with bronchopulmonary dysplasia (BPD) and pulmonary hypertension (PH). However, these associations remain incompletely understood. Objectives: To assess the associations between hsPDA duration and clinical outcomes, PH, and phenotypic differences on lung magnetic resonance imaging (MRI). Methods: In this retrospective cohort study, we identified all infants with BPD at <32 weeks' gestation who also underwent research lung MRI at <48 weeks' postmenstrual age (PMA) from 2014 to 2022. Clinical echocardiograms were reviewed for hsPDA and categorized as no hsPDA, hsPDA 1-60 days, and hsPDA >60 days. Outcome variables included BPD severity, PH at 36 weeks' PMA, PH after 36 weeks' PMA in the absence of shunt (PH-pulmonary vascular disease [PVD]), tracheostomy or death, and lung phenotype by MRI via modified Ochiai score, indexed total lung volume, and whole-lung hyperdensity. Logistic regression and ANOVA were used. Measurements and Main Results: In total, 133 infants born at 26.2 ± 1.9 weeks, weighing 776 ± 276 g, were reviewed (47 with no hsPDA, 44 with hsPDA 1-60 days, and 42 with hsPDA >60 d). hsPDA duration > 60 days was associated with BPD severity (P < 0.01), PH at 36 weeks' PMA (adjusted odds ratio [aOR], 9.7 [95% confidence interval (CI), 3.3-28.4]), PH-PVD (aOR, 6.5 [95% CI, 2.3-18.3]), and tracheostomy or death (aOR, 3.0 [95% CI, 1.0-8.8]). Duration of hsPDA > 60 days was associated with higher Ochiai score (P = 0.03) and indexed total lung volume (P = 0.01) but not whole-lung hyperdensity (P = 0.91). Conclusions: In infants with moderate or severe BPD, prolonged exposure to hsPDA is associated with BPD severity, PH-PVD, and increased parenchymal lung disease by MRI.

中文翻译：

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中度和重度支气管肺发育不良-肺动脉高压的动脉导管未闭和肺磁共振成像表型。


理由：早产儿血流动力学显着的动脉导管未闭 (hsPDA) 与支气管肺发育不良 (BPD) 和肺动脉高压 (PH) 相关。然而，这些关联仍然不完全被理解。目的：评估 hsPDA 持续时间与临床结果、PH 和肺磁共振成像 (MRI) 表型差异之间的关联。方法：在这项回顾性队列研究中，我们确定了 2014 年至 2022 年所有在 <32 周妊娠时患有 BPD 的婴儿，这些婴儿也在 <48 周经后年龄 (PMA) 接受了研究性肺部 MRI 检查。临床超声心动图检查了 hsPDA，并将其分类为无 hsPDA、hsPDA 1-60 天和 hsPDA >60 天。结果变量包括 BPD 严重程度、36 周 PMA 时的 PH、36 周 PMA 后无分流的 PH（PH-肺血管疾病 [PVD]）、气管切开术或死亡，以及通过改良 Ochiai 评分通过 MRI 得出的肺表型，索引肺总容量和全肺高密度。使用逻辑回归和方差分析。测量和主要结果：总共审查了 133 名出生于 26.2 ± 1.9 周、体重 776 ± 276 g 的婴儿（47 名无 hsPDA，44 名 1-60 天患有 hsPDA，42 名患有 hsPDA >60 d）。 hsPDA 持续时间 > 60 天与 BPD 严重程度相关 (P < 0.01)、36 周 PMA 时的 PH（调整后优势比 [aOR], 9.7 [95% 置信区间 (CI), 3.3-28.4]）、PH- PVD（aOR，6.5 [95% CI，2.3-18.3]）和气管切开术或死亡（aOR，3.0 [95% CI，1.0-8.8]）。 hsPDA > 60 天的持续时间与较高的 Ochiai 评分（P = 0.03）和指数总肺体积（P = 0.01）相关，但与全肺高密度无关（P = 0.91）。 结论：在患有中度或重度 BPD 的婴儿中，长时间暴露于 hsPDA 与 BPD 严重程度、PH-PVD 以及 MRI 发现的实质肺疾病增加相关。