Pulmonary Hypertension and Mortality in Premature Infants: The Influence of Patent Ductus Arteriosus and Treatment Approaches

Purpose: Pulmonary hypertension (PH) associated with bronchopulmonary dysplasia presents a significant clinical challenge in premature infants, often complicated by concurrent patent ductus arteriosus (PDA). The absence of age-specific treatments complicates disease management and outcome optimization. This study aimed to evaluate the impact of PH and PDA on mortality in premature infants and assess treatment outcomes of various treatment modalities, including pharmacological and procedural interventions.Methods: This retrospective cohort study included 1,708 premature infants (born at <37 weeks of gestation) treated at Jeonbuk National University Children’s Hospital between January 2013 and August 2023. All infants included in the analysis underwent echocardiographic evaluation. Patients were grouped based on PH and PDA diagnoses, and clinical outcomes, such as mortality, were compared. Statistical analyses, including receiver operating characteristic curves and logistic regression, were conducted.Results: PH and PDA were diagnosed in 46 (2.7%) and 257 (15.0%) patients, respectively. Patients with PH had lower mean gestational ages and birth weights than those of patients with PDA. The mortality rates were 21.7% in patients with PH and 8.2% in those with moderate-to-large PDA. Multivariate analysis identified PH as a significant predictor of mortality. There were no significant differences in mortality between the PDA-treated and untreated groups. Although iloprost use was initially associated with increased mortality, this association was not statistically significant after adjusting for gestational age and birth weightConclusion: PH significantly impacts mortality in premature infants, highlighting the need for early diagnosis and tailored treatments. Continued research is pertinent for enhancing outcomes and the quality of care.