Correlation between exposure to hemodynamically significant patent ductus arteriosus and pulmonary hypertension in children with bronchopulmonary dysplasia
10.3760/cma.j.cn101070-20240819-00525
- VernacularTitle:支气管肺发育不良患儿暴露于有血流动力学意义的动脉导管未闭与发生肺动脉高压的相关性研究
- Author:
Qianhan OUYANG
1
;
Chongbing YAN
;
Bowen WENG
;
Cheng CAI
Author Information
1. 上海交通大学医学院附属儿童医院，上海市儿童医院新生儿科，上海 200062
- Publication Type:Journal Article
- Keywords:
Bronchopulmonary dysplasia;
Pulmonary hypertension;
Patent ductus arteriosus;
Very premature infant
- From:
Chinese Journal of Applied Clinical Pediatrics
2025;40(4):277-282
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the risk of developing pulmonary hypertension (PH) in children with bronchopulmonary dysplasia (BPD) exposed to hemodynamically significant patent ductus arteriosus (hsPDA) and the correlation between PH and exposure to hsPDA.Methods:Retrospective case-control study.The clinical data of extremely premature infants (gestational age <32 weeks) admitted to the Department of Neonatology, Shanghai Children′s Hospital from January 2018 to December 2022 were retrospectively analyzed.All the very premature infants had a corrected gestational age≥36 weeks, required respiratory support, and were diagnosed with BPD.Their echocardiograms were evaluated by a team of physicians specialized in ultrasound.The patients were divided into a non-PH group and a PH group based on whether they were complicated by PH.The risk factors of PH in infant with BPD were analyzed by univariate and multivariate analyses.The influence of hsPDA on the outcome of PH in infant with BPD was analyzed by a Logistic model, whose performance was evaluated by the receiver-operating characteristic (ROC) curve.Results:(1)A total of 147 infants with BPD were included, with 74 cases in the non-PH group and 73 cases in the PH group.There was no significant difference in gestational age[(204.5±11.8) days vs.(201.6±11.5) days] and birth weight[(1 222±273) g vs.(1 153±237) g] between the non-PH and PH groups(all P>0.05).(2)Univariate ANOVA showed the development of PH in children with BPD was significantly related to postnatal positive pressure ventilation resuscitation ( P=0.036), invasive respiratory support ( P=0.002), prenatal glucocorticoids ( P=0.043), intravenous hormones ( P=0.003), liquid restriction ( P<0.001), hypercapnia ( P=0.004), PDA ( P=0.010), and hsPDA ( P<0.001).(3)The Logistic regression analysis suggested that exposure to hsPDA ( OR=5.414, 95% CI: 1.852-15.824, P=0.002) was an independent risk factor for PH development in children with BPD.The ROC curve is plotted through the prediction probability of the model, which has an optimal cut-off value of 42.9% (sensitivity=83.6%, specificity=63.5%, area under the ROC curve=0.794, and Youden index=0.471). Conclusions:Exposure to hsPDA increases the risk and is an independent risk factor of PH development in infants with BPD.
