242 - Patent Ductus Arteriosus and Bronchopulmonary Dysplasia Associated Pulmonary Hypertension: A Case Control Study

Poster Number: 242
Publication Number: 242.222

Samuel Gentle, UAB, Birmingham, AL, United States; Colm P. Travers, University of Alabama at Birmingham, Birmingham, AL, United States; Frank B. Pearce, UAB, Birmingham, AL, United States; Waldemar A. Carlo, University of Alabama at Birmingham, Birmingham, AL, United States; Namasivayam Ambalavanan, University of Alabama School of Medicine, Birmingham, AL, United States

Background: Extremely preterm infants who develop bronchopulmonary dysplasia-associated pulmonary hypertension (BPD-PH) are at higher risk for mortality; however, few modifiable risk factors for BPD-PH are known. We hypothesized that the presence and duration of a patent ductus arteriosus (PDA) would be associated with the development of BPD-PH.

Objective: We hypothesized that the presence and duration of a patent ductus arteriosus (PDA) would be associated with the development of BPD-PH.

Design/Methods: Retrospective case-control study among preterm infants from 22w 0d to 28w 6d born between 2017 and 2020, hospitalized at the University of Alabama at Birmingham, and who remained on respiratory support on postnatal day 28. Infants who developed evidence of echocardiographic pulmonary hypertension (cases) were compared to infants without pulmonary hypertension (controls). Data from all echocardiograms performed during the hospitalization after 28 weeks’ postmenstrual age (PMA) were included. Binary logistic regression analysis was performed adjusting for covariates that differed significantly between groups. A Kaplan-Meier analysis compared the duration of ductal patency between infants with BPD-PH and those with BPD alone.

Results: Over the 4-year period, 136 infants developed BPD alone and 89 infants developed BPD-PH. Infants with BPD-PH were born at a lower gestational age (25.0 ± 1.8 vs 26.2 ± 1.8) and birth weight (652 ± 165 vs 807 ± 209) and had a higher incidence of PDA (45% vs 22%; p< 0.001) and moderate to large PDA (39% vs 19%; p< 0.001) at 28 weeks’ PMA (Table 1). In addition to birth weight and FiO2 at postnatal day 28, both PDA (aOR 3.20; 95% CI 1.62 to 6.32) and moderate to large PDA (aOR 2.64; 95% CI 1.32 to 5.29) were associated with BPD-PH following adjustment by logistic regression (Table 2). The proportion of infants with ductus arteriosus patency differed by postnatal age between infants with BPD-PH and BPD (hazard ratio 2.85; 95% CI 1.85 – 4.38; p< 0.001) (Figure 1).Conclusion(s): In extremely preterm infants on respiratory support on postnatal day 28, BPD-PH was associated with a higher incidence and longer duration of ductus arteriosus patency compared to infants with BPD but without PH.
Table 1
Table 2a: For every 100g increase in birth weight
b: Adjusted for birth weight, small for gestational age, white race, male sex, invasive respiratory support at postnatal day 28, and FiO2 at postnatal day 28.
OD=odds ratio; FiO2=fraction of inspired oxygen; PDA=patent ductus arteriosus; PMA=postmenstrual age