Patent Ductus Arteriosus and Bronchopulmonary Dysplasia–Associated Pulmonary Hypertension

Abstract

ImportanceBronchopulmonary dysplasia (BPD) is often associated with pulmonary vascular disease and secondary pulmonary hypertension (PH). The pathogenesis of BPD-associated PH (BPD-PH) is complex and involves prenatal and postnatal factors that disrupt pulmonary vascular development, and patent ductus arteriosus (PDA) is a factor potentially associated with risk of BPD-PH that has been identified in very recent studies.ObjectiveTo explore the association of PDA with BPD-PH using a bayesian model-averaged (BMA) meta-analysis of studies.Data SourcesPubMed and Embase were searched up to April 2023. Key search terms included BPD and PH.Study SelectionStudies examining infants with gestational age 32 weeks or less and reporting data on PDA and risk of BPD-PH.Data Extraction and SynthesisThis study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the Meta-Analysis of Observational Studies in Epidemiology reporting guidelines. Two independent reviewers extracted data, with a third reviewer checking for accuracy and completeness. Data pooling and effect size calculations were performed by BMA.Main Outcomes and MeasuresThe primary outcome was BPD-PH. BMA was used to calculate Bayes factors (BFs). The BF10 is the ratio of the probability of the data under the alternative hypothesis (H1, association of PDA with BPD-HP) over the probability of the data under the null hypothesis (H0).ResultsA total of 32 studies (8513 infants) were included. BMA showed that the evidence in favor of H1 was weak for any PDA (BF10 = 2.90; 10 studies), moderate for hemodynamically significant PDA (BF10 = 3.77; 3 studies), and extreme for surgically ligated or catheter-occluded PDA (BF10 = 294.9; 16 studies). In contrast, the evidence in favor of H0 was weak for medically treated PDA (BF10 = 0.55; 6 studies). In addition, BMA found strong evidence in favor of H1 when prolonged exposure to PDA was analyzed as a dichotomous variable (BF10 = 11.80; 6 studies) and extreme evidence (BF10 = 113.60; 3 studies) when PDA exposure time was analyzed as a continuous variable.Conclusions and RelevanceIn this bayesian meta-analysis, the data suggest that prolonged exposure to PDA might be associated with increased risk of pulmonary vascular disease in extremely preterm infants. This highlights the need to monitor for PH in high-risk preterm infants with prolonged exposure to PDA and to incorporate PH risk into clinical decisions regarding PDA management.

Comparison of porcine versus bovine surfactant in preterm respiratory distress syndrome: Evidence from real‐world data. A multicentre collaboration from Karnataka

“…Although single‐center observational studies have shown no association between BPD and small PDA, the association is apparent when the shunt persists for 7–14 days across PDA. Although studies have shown an association between moderate‐severe PDA and BPD, treating the PDA has not shown consistent results in the reduction of BPD and is a matter of debate 13,14 . In our cohort, there was an association; efficacy needs to be proven in large clinical trials.…”