Association of patent ductus arteriosus duration with bronchopulmonary dysplasia and mortality: a cohort study

BACKGROUND: We evaluated if the number of days of exposure to a hemodynamically significant patent ductus arteriosus (hsPDA) is associated with bronchopulmonary dysplasia (BPD) and/or mortality in preterm infants. METHODS: We conducted a retrospective cohort study of preterm infants (birth weight <= 1500 g or gestational age < 30 weeks), admitted between January 2017 to December 2022. HsPDA was defined using Neonatologist Performed Echocardiography criteria. Logistic regression was used to assess the relationship between the duration of hsPDA and BPD/death. Additional analyses explored non-linear associations using penalized splines and quadratic functions. RESULTS: We included 424 neonates: 204 developed BPD/death. The duration of hsPDA was associated to increased risk of BPD/death (OR = 1.67, 95% CI 1.17-2.56, p < 0.001), adjusted for birth weight, 5 ' APGAR score, IVH, durations of mechanical and non-invasive ventilation. We found a progressive increase in the OR for BPD/death during the first week of exposure, followed by a plateau. CONCLUSION: The duration of exposure to hsPDA is associated with adverse neonatal outcomes, (BPD/ death). The risk progressively increases during the first week of exposure followed by a plateau. These findings suggest that the first week of exposure may represent a critical window of opportunity.