Related Experiment Video
Updated: Jul 9, 2025
Hemodynamic Precision in the Neonatal Intensive Care Unit using Targeted Neonatal Echocardiography
Published on: January 27, 2023
Patent Ductus Arteriosus and Bronchopulmonary Dysplasia-Associated Pulmonary Hypertension: A Bayesian Meta-Analysis
Eduardo Villamor1, Elke van Westering-Kroon1, Gema E Gonzalez-Luis2
1Division of Neonatology, Department of Pediatrics, MosaKids Children's Hospital, Maastricht University Medical Center (MUMC+), School for Oncology and Reproduction (GROW), Maastricht University, Maastricht, The Netherlands.
Insights
Prolonged exposure to patent ductus arteriosus (PDA) is linked to a higher risk of pulmonary hypertension in extremely preterm infants. Monitoring and managing PH risk in these infants is crucial for clinical decisions.
Area of Science:
- Neonatal Medicine
- Pediatric Cardiology
- Pulmonary Hypertension Research
Background:
- Bronchopulmonary dysplasia (BPD) is frequently complicated by pulmonary vascular disease and secondary pulmonary hypertension (PH).
- The development of BPD-associated PH (BPD-PH) is complex, influenced by prenatal and postnatal factors disrupting pulmonary vascular growth.
- Recent studies suggest a potential association between patent ductus arteriosus (PDA) and the risk of BPD-PH.
Approach:
- A Bayesian model-averaged (BMA) meta-analysis was conducted to investigate the association between PDA and BPD-PH.
- Searches of PubMed and Embase up to April 2023 identified studies involving infants with gestational age ≤32 weeks reporting data on PDA and BPD-PH risk.
- Data extraction and synthesis followed PRISMA and MOOSE guidelines, with BMA used for effect size calculations and Bayes factors (BFs) to quantify evidence.
Key Points:
- Analysis of 32 studies (8513 infants) revealed varying levels of evidence for PDA's association with BPD-PH.
- Extreme evidence supported an association for surgically ligated/catheter-occluded PDA (BF10=294.9) and prolonged PDA exposure (dichotomous: BF10=11.80; continuous: BF10=113.60).
- Weak evidence supported an association for any PDA (BF10=2.90), moderate for hemodynamically significant PDA (BF10=3.77), and weak evidence favored the null hypothesis for medically treated PDA (BF10=0.55).
Conclusions:
- The findings suggest that prolonged PDA exposure may increase the risk of pulmonary vascular disease in extremely preterm infants.
- This highlights the importance of monitoring for PH in high-risk preterm infants with extended PDA exposure.
- Clinical decisions regarding PDA management should incorporate the assessed risk of PH.
Importance:
Bronchopulmonary 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.
Objective:
To explore the association of PDA with BPD-PH using a bayesian model-averaged (BMA) meta-analysis of studies.
Data Sources:
PubMed and Embase were searched up to April 2023. Key search terms included BPD and PH.
Study Selection:
Studies examining infants with gestational age 32 weeks or less and reporting data on PDA and risk of BPD-PH.
Data Extraction And Synthesis:
This 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 Measures:
The 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).
Results:
A 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 Relevance:
In 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.
More Related Videos
08:34Left Atrial Stenosis Induced Pulmonary Venous Arterialization and Group 2 Pulmonary Hypertension in Rat
Published on: November 18, 2018
10:20Right Ventricular Systolic Pressure Measurements in Combination with Harvest of Lung and Immune Tissue Samples in Mice
Published on: January 16, 2013
