Kim Sol, Seo Yumi, Oh Moon-Yeon, Kim Min Soo, Yum Sook Kyung
Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea.
Department of Pediatrics, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea.
Biomedicines. 2025 Jul 15;13(7):1725. doi: 10.3390/biomedicines13071725.
: Pulmonary hypertension and hemodynamically significant PDA (hsPDA) involve seemingly opposite physiological features-decreased pulmonary blood flow and pulmonary overcirculation, respectively-but the literature demonstrates variable respiratory consequences in association with each of these morbidities. The aim of this study is to evaluate whether the two factors representing pulmonary circulation provide different contributions to respiratory outcomes in preterm infants with and without pulmonary hypoplasia. : The medical records of preterm very low birth weight (VLBW) infants admitted to our unit during the study period from January 2013 to December 2020 were retrospectively reviewed. Preterm VLBW infants were divided into groups according to the presence of presumed pulmonary hypoplasia (PPH). Multivariable logistic regression analysis was performed to assess the association of PPH and pulmonary hypertension or delayed PDA closure with in-hospital outcomes. : Postnatal age at final treatment for PDA was significantly later [median 33 vs. 19 days, = 0.025] in the PPH group. Multivariable analysis indicated that early pulmonary hypertension was significantly associated with neonatal death [aOR (95%CI) 11.575 (2.988-44.833) for no-PPH vs. 9.981 (1.334-74.647) for PPH]. Delayed PDA closure was associated with increased odds of adverse respiratory and composite outcomes [aOR (95%CI) 4.929 (1.613-15.055) and 3.320 (1.048-10.515), respectively] but decreased odds of neonatal death in the no-PPH group. However, Cox proportional hazards models did not demonstrate statistically significant associations for PPH, early pulmonary hypertension, or delayed PDA closure with mortality, likely due to time-varying effects and the absence of death events in the subgroup of infants with both PPH and delayed PDA closure. : PPH is associated with a higher prevalence of air leak syndrome and pulmonary hypertension. Delayed PDA closure exerts different effects on respiratory outcomes in preterm VLBW infants with and without PPH. Although early pulmonary hypertension appears to be a key circulatory factor contributing to neonatal death, its effect may vary over time. These findings underscore the importance of accounting for time-dependent effects when interpreting pulmonary circulatory risk factors in clinical practice.
肺动脉高压和血流动力学上具有显著意义的动脉导管未闭（hsPDA）分别涉及看似相反的生理特征——肺血流减少和肺循环过度，但文献表明，与这些疾病中的每一种相关的呼吸后果各不相同。本研究的目的是评估代表肺循环的两个因素对有无肺发育不全的早产儿呼吸结局的贡献是否不同。
回顾性分析了2013年1月至2020年12月研究期间入住我科的极低出生体重（VLBW）早产儿的病历。根据假定的肺发育不全（PPH）情况将VLBW早产儿分组。进行多变量逻辑回归分析，以评估PPH、肺动脉高压或动脉导管未闭延迟关闭与住院结局之间的关联。
PPH组动脉导管未闭最终治疗时的出生后年龄显著更晚[中位数33天对19天，P = 0.025]。多变量分析表明，早期肺动脉高压与新生儿死亡显著相关[无PPH组的调整后比值比（95%置信区间）为11.575（2.988 - 44.833），PPH组为9.981（1.334 - 74.647）]。动脉导管未闭延迟关闭与不良呼吸和综合结局的几率增加相关[调整后比值比（95%置信区间）分别为4.929（1.613 - 15.055）和3.320（1.048 - 10.515）]，但在无PPH组中与新生儿死亡几率降低相关。然而，Cox比例风险模型未显示PPH、早期肺动脉高压或动脉导管未闭延迟关闭与死亡率之间存在统计学显著关联，可能是由于时变效应以及PPH和动脉导管未闭延迟关闭并存的婴儿亚组中无死亡事件。
PPH与空气泄漏综合征和肺动脉高压的较高患病率相关。动脉导管未闭延迟关闭对有无PPH的VLBW早产儿的呼吸结局有不同影响。虽然早期肺动脉高压似乎是导致新生儿死亡的关键循环因素，但其影响可能随时间变化。这些发现强调了在临床实践中解释肺循环危险因素时考虑时间依赖性效应的重要性。
