Related Experiment Video
Updated: Apr 14, 2026
Hemodynamic Precision in the Neonatal Intensive Care Unit using Targeted Neonatal Echocardiography
Published on: January 27, 2023
Association between Hemodynamically Significant Patent Ductus Arteriosus and Bronchopulmonary Dysplasia
Federico Schena1, Gaia Francescato1, Alessia Cappelleri1
1Neonatology and Neonatal Intensive Care Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
Insights
The duration and severity of a patent ductus arteriosus (PDA) shunt in premature infants are linked to increased risks of bronchopulmonary dysplasia (BPD) or death. A standardized PDA staging system aids in evaluating this association and guiding treatment.
Area of Science:
- Neonatalogy
- Pediatric Cardiology
- Respiratory Medicine
Background:
- Patent ductus arteriosus (PDA) is common in preterm infants and can lead to significant morbidities.
- The relationship between PDA shunt characteristics and outcomes like bronchopulmonary dysplasia (BPD) requires further clarification.
Purpose of the Study:
- To investigate the association between the duration and magnitude of PDA shunt and the incidence of BPD or death in preterm infants.
- To evaluate the utility of a standardized PDA staging system in assessing PDA-related morbidities.
Main Methods:
- Retrospective analysis of 242 infants born at ≤ 28 weeks gestational age between 2007 and 2012.
- Echocardiographic evaluations were reviewed to assess PDA presence and severity using the McNamara and Sehgal PDA staging system.
- Infants were divided into groups based on the development of BPD or death.
Main Results:
- Infants who developed BPD or died had hemodynamically significant PDA (E3/E4) for a longer duration (4.8 days) compared to those who did not (2.3 days).
- Each week of a hemodynamically significant PDA increased the risk of BPD (OR 1.7); persistence of a non-significant PDA (E2) was not associated with BPD.
- Surgical ligation of PDA was not an independent risk factor, but later ligation and prolonged PDA duration were associated with BPD or death.
Conclusions:
- A standardized PDA staging system is valuable for evaluating PDA morbidities and comparing research.
- The duration and severity of hemodynamically significant PDA are critical factors associated with BPD or death in preterm infants.
- This scoring system can assist in guiding clinical management decisions for PDA in neonates.
Objective:
To assess whether the duration and magnitude of the shunt with patent ductus arteriosus (PDA) are related to a higher incidence of bronchopulmonary dysplasia (BPD) or death.
Study Design:
A total of 242 infants ≤ 28 weeks gestational age were evaluated retrospectively between 2007 and 2012; 105 (43.3%) developed BPD or died (group 1) and 137 (56.6%) did not (group 2). A review of all echocardiographic evaluations performed from birth up to 36 weeks of postconceptional age or final ductal closure was carried out, to detect the presence of PDA, and estimate the severity of ductal shunt through the "PDA staging system" proposed by McNamara and Sehgal.
Results:
Group 1 presented with a hemodynamically significant ductus arteriosus (DA) (E3 and/or E4-PDA) for a longer period of time vs group 2: 4.8 vs 2.3 days, respectively (P < .001). Persistence of a nonsignificant DA (E2) was not associated with development of BPD (P = .16). Each week of a hemodynamically significant DA represented an added risk for BPD (OR 1.7), and the duration of a small, nonsignificant DA (E2) did not. Surgical ligation of PDA itself was not found to be an independent risk factor for BPD. In the subgroup of patients who received ligation, a later ligation (33 vs 23 days) and a prolonged PDA were the only factors associated to BPD or death.
Conclusions:
A shared scoring system of the severity of ductal shunt is helpful to correctly evaluate the association between PDA morbidities, to compare scientific studies, and to guide treatment.
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