Echocardiographic hemodynamics during early postnatal period and 3-year neurodevelopment outcomes in preterm infants

BACKGROUND: The relationship between early echocardiographic markers of patent ductus arteriosus (PDA)-related hemodynamics and long-term neurodevelopmental outcomes in preterm infants remains unclear. METHODS: We analyzed data from a multicenter registry of infants born at 23-29 weeks. Echocardiographic data obtained within the first 14 days were used to assess hemodynamic burden, including the PLASE (PDA and Left Atrial Size Evaluation) score. The primary outcome was an adverse neurodevelopmental outcome at 3 years. Associations were evaluated overall and by gestational-age strata. RESULTS: Among 399 infants, 30% developed adverse neurodevelopmental outcomes. Overall, higher PLASE scores were associated with adverse outcomes. Among infants born at 25-26 weeks, those with adverse outcomes had higher PLASE scores than those without adverse outcomes. In the 27-28-week group, infants with adverse neurodevelopmental outcomes had smaller left atrial volumes and lower left ventricular dimensions than those without them. No consistent associations were observed in the 23-24-week group. Although surgical ligation was associated with worse unadjusted outcomes, differences were not significant after gestational-age stratification. CONCLUSIONS: Early PDA-related hemodynamic burden, as assessed by the PLASE score, was associated with adverse neurodevelopmental outcomes at 3 years, with associations most apparent in infants born at 25-26 weeks. IMPACT: Patent ductus arteriosus (PDA)-related hemodynamic burden, assessed by serial echocardiography, was associated with neurodevelopmental outcomes at 3 years. Associations varied across gestational age strata, with associations most apparent among infants born at 25-26 weeks' gestation. In extremely preterm infants born at 23-24 weeks' gestation, profound biological immaturity and competing morbidities may obscure the contribution of PDA-related hemodynamics to long-term neurodevelopment, highlighting the relevance of gestational age-stratified analyses. These findings suggest that echocardiographic assessment of PDA-related hemodynamics, rather than PDA presence or surgical intervention alone, may refine risk stratification and support individualized circulatory management in preterm infants.

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Journal
Pediatric Research
Published
2026-07-27
DOI
https://doi.org/10.1038/s41390-026-05324-6
Primary Topic
Cardiovascular Conditions and Treatments
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article
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article

Echocardiographic hemodynamics during early postnatal period and 3-year neurodevelopment outcomes in preterm infants

Toshifumi Ikeda, Akane Honda, Shoichiro Amari, Kenichi Tanaka et al.
Pediatric Research
Cardiovascular Conditions and Treatments
article

Echocardiographic hemodynamics during early postnatal period and 3-year neurodevelopment outcomes in preterm infants

Toshifumi Ikeda, Akane Honda, Shoichiro Amari, Kenichi Tanaka, Nanae Yutaka, Yusei Nakata, Masahiko Sato, Hiroshi Sugiura, Jun Shiraishi, Tetsuya Isayama, Mitsumaro Nii, Atsushi Ohashi, Kyongsun Pak, Satoshi Masutani, Hidenori Kawasaki, Tomoko Fuke, Kaoru Okazaki, Seiichi Tomotaki, Atsushi Nakao, Masahito Yamamoto, Shun Matsumura, Satoshi Kusuda, Masayuki Miwa, Naoko Okada, Aiko Aoyama, Hiroyuki Kitano, Tomohiro Hayashi, Atsushi Matsumoto, Takehiko Yokoyama, Takashi Tachibana, Kenichi Masumoto, Hiroki Ishii, Atsushi Nakayama, Satoshi Onishi, Masaki Kobayashi, Yusuke Suganami, Tohru Kobayashi, Tomoko Saito, Miki Shitomi, PLASE STUDY SUBGROUP OFFICE, Tomoyuki Kamamoto, Masafumi Miyata, Katsuaki Toyoshima, Yoshiaki Sato, Yutaka Yamamoto, Hiroko Iwami, on behalf of PLASE (Patent ductus arteriosus and Left Atrial Size Evaluation in preterm infants) Study Group
article en

Abstract

BACKGROUND: The relationship between early echocardiographic markers of patent ductus arteriosus (PDA)-related hemodynamics and long-term neurodevelopmental outcomes in preterm infants remains unclear. METHODS: We analyzed data from a multicenter registry of infants born at 23-29 weeks. Echocardiographic data obtained within the first 14 days were used to assess hemodynamic burden, including the PLASE (PDA and Left Atrial Size Evaluation) score. The primary outcome was an adverse neurodevelopmental outcome at 3 years. Associations were evaluated overall and by gestational-age strata. RESULTS: Among 399 infants, 30% developed adverse neurodevelopmental outcomes. Overall, higher PLASE scores were associated with adverse outcomes. Among infants born at 25-26 weeks, those with adverse outcomes had higher PLASE scores than those without adverse outcomes. In the 27-28-week group, infants with adverse neurodevelopmental outcomes had smaller left atrial volumes and lower left ventricular dimensions than those without them. No consistent associations were observed in the 23-24-week group. Although surgical ligation was associated with worse unadjusted outcomes, differences were not significant after gestational-age stratification. CONCLUSIONS: Early PDA-related hemodynamic burden, as assessed by the PLASE score, was associated with adverse neurodevelopmental outcomes at 3 years, with associations most apparent in infants born at 25-26 weeks. IMPACT: Patent ductus arteriosus (PDA)-related hemodynamic burden, assessed by serial echocardiography, was associated with neurodevelopmental outcomes at 3 years. Associations varied across gestational age strata, with associations most apparent among infants born at 25-26 weeks' gestation. In extremely preterm infants born at 23-24 weeks' gestation, profound biological immaturity and competing morbidities may obscure the contribution of PDA-related hemodynamics to long-term neurodevelopment, highlighting the relevance of gestational age-stratified analyses. These findings suggest that echocardiographic assessment of PDA-related hemodynamics, rather than PDA presence or surgical intervention alone, may refine risk stratification and support individualized circulatory management in preterm infants.

Pediatric Research
Kansai Medical University (JP), Sapporo Medical University (JP), Fujita Health University (JP), Tokyo Medical University (JP), Iwate Medical University (JP), University of Kochi (JP), Kyoto University (JP), Kurashiki Central Hospital (JP), Aomori Prefectural Central Hospital (JP), Osaka Women's and Children's Hospital (JP), Osaka City General Hospital (JP), Japanese Red Cross Medical Center (JP), Hiroshima City Asa Citizens Hospital (JP), Yodogawa Christian Hospital (JP), Kanagawa Children's Medical Center (JP), Ishikawa Prefectural Central Hospital (JP), Seirei Hamamatsu General Hospital (JP), Japanese Red Cross Nagoya Daiichi Hospital (JP), National Center For Child Health and Development (JP), Gifu Prefectural General Medical Center (JP), Saitama Municipal Hospital (JP), Shibuya (Japan) (JP), Tokyo Women's Medical University (JP), Tokyo Metropolitan Children's Medical Center (JP), Nagahama City Hospital (JP), Japanese Red Cross Nagoya Daini Hospital (JP), Asahikawa Kosei Hospital (JP), Social Insurance Saitama Chuo Hospital (JP), Tokyo Women's Medical University Yachiyo Medical Center, Nagoya University (JP), Nara Medical University (JP), Saitama Medical University (JP), Kumamoto University (JP)
Ministry of Education, Culture, Sports, Science and Technology, Japan Society for the Promotion of Science
Good health and well-being
Openalex Percentile: Top 9%
Cardiovascular Conditions and Treatments
DOIOpen Access PDFOpenAlex
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