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A patent ductus arteriosus (PDA) in premature newborn remaining wide open is associated with broncho-pulmonary dysplasia a form of chronic lung disease.

Marc Buchet

12 May 2024

In infants with moderate or severe Bronchopulmonary dysplasia (BPD) prolonged exposure to hsPDA is associated with BPD severity, PH-PVD, and increased parenchymal lung disease by MRI.

In Europe, preterm birth is one of the two leading causes for neonatal mortality and accounts for more than half of all deaths in later childhood. Prevalence rates of preterm birth range from 5.4 to 12.0 % – an average of 7.3% of all live births

A Patent ductus arteriosus (PDA) is a persistent opening between the two major blood vessels leading from the heart.

Before a baby is born, the fetus's blood does not need to go to the lungs to get oxygenated. The ductus arteriosus is a hole that allows the blood to skip the circulation to the lungs. However, when the baby is born, the blood must receive oxygen in the lungs and this hole is supposed to close. If the ductus arteriosus is still open (or patent) the blood may skip this necessary step of circulation. The open hole is called the patent ductus arteriosus.

Every baby is born with a ductus arteriosus. After birth, the opening is no longer needed and it usually narrows and closes within the first few days.

Sometimes, the ductus doesn't close after birth. Failure of the ductus to close is common in premature infants but rare in full-term babies. In most children, the cause of PDA isn't known. Some children can have other heart defects along with the PDA.

Since years we know that a patent ductus remaining persistent is associated with increased mortality.

But over the past years, controversy appears about when, to which neonates and how to close this ductus.

This eluded somehow to many clinicians the strong set of old data support evidences of increased mortality and morbidity with PDA en neonates.

This new publication refresh the facts and update them under the current new standard of care.

Here, Bjorkman and colleagues provide compelling evidence of an association between prolonged exposure (>60 days) to hsPDA and worsened outcomes, including BPD-PH and risk of death or tracheostomy. In addition, by using MRI, they also provide promising new information on the pattern of lung damage associated with prolonged exposure to hsPDA.

MRI findings were assessed using three tools: 1) modified Ochaia score, 2) indexed total lung volume (TLVI), and 3) whole lung hyperdensity (WLH) (16). While the Ochaia score is a general assessment of the severity of lung damage, measurements of lung hyperdensity and lung volume are novel techniques recently developed to quantify lung parenchymal abnormalities.

According to the authors, an increase in lung volume is associated with small airway disease and air trapping, whereas an increase in lung hyperdensity is associated with inflammation, atelectasis, and fibrosis.

Finally, the data from Bjorkman and colleagues confirm that PDA is not an "innocent bystander", at least for a subset of extremely preterm infants.

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