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.