Tissue Doppler Imaging, Pulmonary Haemodynamics and Conventional Echocardiographic Indices for Early Bronchopulmonary Dysplasia Prediction in Preterm Infants: A Prospective Observational Feasibility Study

Background/Objectives: Bronchopulmonary dysplasia (BPD) remains a major complication of prematurity, yet no prediction model incorporating echocardiographic assessment of right ventricle (RV) function and pulmonary haemodynamics exists. This study aimed to identify clinical and echocardiographic candidate variables of BPD to inform the design of a future multicentre study for BPD prediction model construction. Methods: This prospective observational feasibility study recruited preterm infants born before 32 weeks of gestation. Echocardiographic scans were performed at Day 5 and Day 9 postnatally. Candidate variables across six domains, clinical, RV systolic, diastolic, and global function, pulmonary-haemodynamics, and patent ductus arteriosus (PDA) variables, were evaluated using Mann–Whitney U tests and univariable logistic regression. Results: Of 40 preterm infants enrolled, 27 (68%) developed BPD. The BPD group had lower gestational age (median 26 vs. 30 weeks, OR 0.50, p < 0.001), lower current weight (median 763 vs. 1200 g, OR 0.54, p = 0.002), and higher mean airway pressure (OR 1.86, p = 0.002). By Day 5, significant differences included higher normalised RV s’ (OR 2.26, p = 0.042), shorter RVET (OR 0.49, p = 0.018), elevated RV-MPI-PW (OR 2.28, p = 0.019), shorter PAAT (OR 0.72, p = 0.047), and larger normalised PDA diameter (OR 1.70, p = 0.002). By Day 9, normalised RV a’ (OR 1.93, p = 0.015), RV E/e’ ratio (OR 2.03, p = 0.033), and RV e’/a’ ratio (OR 0.54, p = 0.019) additionally emerged. All infants with reversed anterior–cerebral–artery diastolic flow subsequently developed BPD. Conclusions: Clinical and echocardiographic variables across multiple RV-function, PDA and pulmonary vascular domains were identified as candidate variables for BPD, providing a conceptual framework for a future multicentre prediction model study.