Eduardo Villamor, Elkevan Westering-Kroon, Gema E. Gonzalez-Luis, František Bartoš, Steven H. Abman, Maurice J. Huizing
MosaKids Children’s Hospital and Maastricht University Medical Center. Hospital Universitario Materno-Infantil de Canarias. University of Amsterdam. University of Colorado Anschutz School of Medicine and Children’s Hospital Colorado, Aurora.
Netherlands, Spain and United States
Journal of the American Medical Association Network Open
JAMA Netw Open 2023;
DOI: 10.1001/jamanetworkopen.2023.45299
Abstract
Importance: Bronchopulmonary dysplasia (BPD) is often associated with pulmonary vascular disease and secondary pulmonary hypertension (PH). The pathogenesis of BPD-associated PH (BPD-PH) is complex and involves prenatal and postnatal factors that disrupt pulmonary vascular development, and patent ductus arteriosus (PDA) is a factor potentially associated with risk of BPD-PH that has been identified in very recent studies.
Objective: To explore the association of PDA with BPD-PH using a bayesian model-averaged (BMA) meta-analysis of studies.
Data sources: PubMed and Embase were searched up to April 2023. Key search terms included BPD and PH.
Study selection: Studies examining infants with gestational age 32 weeks or less and reporting data on PDA and risk of BPD-PH.
Data extraction and synthesis: This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the Meta-Analysis of Observational Studies in Epidemiology reporting guidelines. Two independent reviewers extracted data, with a third reviewer checking for accuracy and completeness. Data pooling and effect size calculations were performed by BMA.
Main outcomes and measures: The primary outcome was BPD-PH. BMA was used to calculate Bayes factors (BFs). The BF10 is the ratio of the probability of the data under the alternative hypothesis (H1, association of PDA with BPD-HP) over the probability of the data under the null hypothesis (H0).
Results: A total of 32 studies (8513 infants) were included. BMA showed that the evidence in favor of H1 was weak for any PDA (BF10 = 2.90; 10 studies), moderate for hemodynamically significant PDA (BF10 = 3.77; 3 studies), and extreme for surgically ligated or catheter-occluded PDA (BF10 = 294.9; 16 studies). In contrast, the evidence in favor of H0 was weak for medically treated PDA (BF10 = 0.55; 6 studies). In addition, BMA found strong evidence in favor of H1 when prolonged exposure to PDA was analyzed as a dichotomous variable (BF10 = 11.80; 6 studies) and extreme evidence (BF10 = 113.60; 3 studies) when PDA exposure time was analyzed as a continuous variable.
Conclusions and relevance: In this bayesian meta-analysis, the data suggest that prolonged exposure to PDA might be associated with increased risk of pulmonary vascular disease in extremely preterm infants. This highlights the need to monitor for PH in high-risk preterm infants with prolonged exposure to PDA and to incorporate PH risk into clinical decisions regarding PDA management.
Category
Class III. Pulmonary Hypertension Associated with Lung Disease
Class I. Pulmonary Hypertension Associated with Congenital Cardiovascular Disease
Age Focus: Pediatric Pulmonary Vascular Disease
Fresh or Filed Publication: Filed (PHiled). Greater than 1-2 years since publication
Article Access
Free PDF File or Full Text Article Available Through PubMed or DOI: Yes