Prolonged Respiratory Support May Amplify Heart-Lung Risk in Preterm Infants

Very preterm infants with a patent ductus arteriosus (PDA) that stays open for two weeks or longer face higher rates of moderate or severe bronchopulmonary dysplasia (BPD), death, and the combined outcome of BPD or death, but only when they also need at least ten days of invasive respiratory support, according to a secondary analysis of the multicenter, prospective INTERPDA cohort published in the Journal of Perinatology.

The study, conducted by the Turkish Neonatal Society INTERPDA Study Group, included 363 infants born at less than 29 weeks’ gestation who had a moderate-to-large PDA and required respiratory support. The researchers stratified the infants by PDA exposure duration, comparing those exposed for fewer than 14 days with those exposed for 14 days or more, and by cumulative duration of invasive respiratory support, comparing fewer than 10 days with 10 days or more.

Prolonged PDA exposure was associated with higher rates of moderate/severe BPD, BPD or death, and mortality only in the subgroup of infants requiring 10 or more days of invasive respiratory support. In infants with shorter respiratory support duration, the association was not observed.

Importantly, the link held up statistically. In adjusted analyses, prolonged PDA exposure remained independently associated with these adverse pulmonary outcomes, suggesting that the relationship is not explained solely by the baseline characteristics captured in the cohort.

The authors conclude that prolonged PDA exposure is associated with adverse pulmonary outcomes primarily in infants with prolonged respiratory dependence. This pattern supports an individualized, physiology-based approach to PDA management in very preterm infants, in which the duration of invasive respiratory support may help identify which infants are most vulnerable to the consequences of a persistently open ductus. As a secondary analysis of an observational cohort, the findings show associations rather than proven causal effects of treatment decisions, and they apply to infants born before 29 weeks with moderate-to-large PDAs who needed respiratory support.

Subject of Research: Association between prolonged patent ductus arteriosus exposure and bronchopulmonary dysplasia in very preterm infants by duration of invasive respiratory support

Article Title: Respiratory support duration and the association between patent ductus arteriosus exposure and bronchopulmonary dysplasia

Article References: Okulu, E., Erdeve, O., Arslan, Z., Demirel, N., Akcan, A. B., Erdogan, F. T., Bulbul, A., Uslu, H. S., Oncel, M. Y., Ozkan, H., Koksal, N., Koc, E., Tekgunduz, K. S., Kara, M., Kaya, H., Gokce, I. K., Celik, K., Yalinkilic, D., Ertugrul, S., … on behalf of the Turkish Neonatal Society INTERPDA Study Group (2026). Respiratory support duration and the association between patent ductus arteriosus exposure and bronchopulmonary dysplasia. Journal of Perinatology. https://doi.org/10.1038/s41372-026-02934-0

Image Credits: AI Generated

DOI: 10.1038/s41372-026-02934-0

Keywords: patent ductus arteriosus, bronchopulmonary dysplasia, very preterm infants, respiratory support, neonatology, INTERPDA cohort, Journal of Perinatology, prematurity, lung disease, mortality, Respiratory, support