The effect of prolonged tracheal intubation on the association between patent ductus arteriosus and bronchopulmonary dysplasia (grades 2 and 3)

OBJECTIVE: To determine if the need for mechanical ventilation alters the association between prolonged patent ductus arteriosus (PDA) exposure and bronchopulmonary dysplasia (grades 2 and 3) (BPD). STUDY DESIGN: Observational study of 407 infants (<28 weeks’ gestation) with echocardiograms performed at planned intervals. RESULTS: Twelve percent (48/407) of study infants had BPD (grades 2 & 3). In a multivariable regression model, exposure to a moderate-to-large PDA shunt for ≥7 days was associated with an increased risk of BPD (grades 2 & 3) (from 16% to 35%: aRD=19% (6, 32%), p<0.005) when infants required ≥10 days of intubation (n=170). In contrast, there was no significant association between prolonged PDA exposure and BPD when infants required ≤9 days of intubation (aRD=4% (−1, 10%) (n=237). CONCLUSION: Moderate-to-large PDAs are associated with an increased risk of BPD - but only when infants require intubation ≥10 days.