Patent Ductus Arteriosus and Lung Magnetic Resonance Imaging Phenotype in Moderate and Severe Bronchopulmonary Dysplasia–Pulmonary Hypertension
Kurt Bjorkman, Kimberley G. Miles, L. Bellew, Kristin Schneider, Stephanie Melissa Magness, Nara S. Higano, Nicholas J. Ollberding, X. Hoyos Cordon, Russel Hirsch, Erik B. Hysinger, Jason C. Woods, Paul J. Critser
Abstract
Abstract 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.