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  • Clinical Research Article
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Hemodynamically significant PDA impacts adverse outcomes in infants with BPD: a multicenter study

Pediatric Research (2026)Cite this article

Abstract

Background

Bronchopulmonary 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.

Methods

A 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.

Results

The 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).

Conclusion

In 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.

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Data availability

The datasets generated during or analyzed during the current study are not publicly available due to patient privacy, but are available from the corresponding author on reasonable request.

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Acknowledgements

The authors acknowledge the financial support from the special project of the Action Plan of “Science and Technology Rejuvenating Mongolia” of Shanghai Jiao Tong University in 2023 (2023XYJG0001-01-09) and the 2023 hospital-level Clinical Research Training Project of Shanghai Children’s Hospital (2023YLY02). The authors acknowledge Feng Tienan, statistician at the Clinical Research Institute of Shanghai Jiao Tong University School of Medicine, Qu Tiantian, project manager, and Chen Zhaoxia and Huang Xuequn, database developers, for their valuable contributions to this research. The authors also thank all participants for their efforts in performing this study.

Funding

This study was financially supported by the Special Project of the Action Plan of “Science and Technology Rejuvenating Mongolia” of Shanghai Jiao Tong University in 2023 (grant number 2023XYJG0001-01-09) and the 2023 Hospital-Level Clinical Research Training Project of Shanghai Children’s Hospital (grant number 2023YLY02).

Author information

Author notes

  1. Qianhan Ouyang

    Present address: Department of Neonatology, Jiading District Maternal and Child Health Hospital, Shanghai, China

  2. These authors contributed equally: Qianhan Ouyang, Fei Bei.

Authors and Affiliations

  1. Department of Neonatology, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China

    Qianhan Ouyang, Chongbing Yan, Bowen Weng, Yuanyang Zhang & Cheng Cai

  2. Department of Neonatology, Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China

    Fei Bei

  3. Department of Neonatology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China

    You You & Hongping Xia

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Contributions

Manuscript writing, data collection, data organization, statistical analysis: Qianhan Ouyang. Research supervision: Fei Bei. Data collection, data organization: Chongbing Yan, Bowen Weng, Yuanyang Zhang, You You. Research supervision, manuscript revision: Hongping Xia. Research supervision, manuscript revision, funding support: Cheng Cai.

Corresponding authors

Correspondence to Hongping Xia or Cheng Cai.

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Competing interests

The authors declare no competing interests.

Ethics approval

This study was approved by the Medical Ethics Committee of Shanghai Children’s Hospital (Approval number: 2024RY069-E01) and certifies that the study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki. The study was retrospective, did not involve a diagnostic intervention for children, and informed consent was waived.

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Ouyang, Q., Bei, F., Yan, C. et al. Hemodynamically significant PDA impacts adverse outcomes in infants with BPD: a multicenter study. Pediatr Res (2026). https://doi.org/10.1038/s41390-026-04772-4

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