[Predictive value of lung ultrasound scores for bronchopulmonary dysplasia in very low birth weight infants with patent ductus arteriosus].

Objective: To evaluate the value of early lung ultrasound score (LUS) in predicting subsequent bronchopulmonary dysplasia (BPD) in very low birth weight (VLBW) infants with patent ductus arteriosus (PDA). Methods: This retrospective cohort study was conducted in two phases. In phase 1, 223 VLBW infants with PDA admitted to Women and Children's Hospital, Qingdao University between January 2021 and January 2024 were enrolled. Gestational age, birth weight, 5-minute Apgar score ≤7, antenatal steroid use, and LUS at days 7 and 14 of life were collected and compared between the BPD and non-BPD groups to assess their predictive values for BPD. In phase 2, 42 VLBW infants admitted from January 2024 to May 2025 were enrolled and categorized according to PDA management strategy (early-intervention, conservative-treatment, and control groups). The conservative-treatment group was further divided into BPD and non-BPD subgroups. LUS at day 14 of life was collected to evaluate its utility in guiding the timing of transcatheter PDA closure (TCPC) to BPD prevention. Between-group comparisons were performed using paired t-test, one-way ANOVA, Mann-Whitney U test, Kruskal-Wallis H test or chi-square test. Results: In phase 1, among the 223 VLBW infants, 118 were males, with the gestational age of 29.9 (27.4, 31.0) weeks. LUS at days 7 and 14 of life were significantly higher in the BPD group than in the non-BPD group (Z=125.42 and 147.23, respectively; both P<0.001). The correlation coefficient between day-14 LUS and BPD was 0.76. In phase 2, of the 42 VLBW infants, 25 were males, 17 were females, with the gestational age (27.3±1.4) weeks. The early-intervention group showed significantly lower post-operative LUS (t=8.49, P<0.001). No significant difference was found between the early-intervention group and conservative-treatment-BPD subgroup (13.3±2.1 vs. 13.2±1.5, t=0.09, P>0.05); both were significantly higher than that in the conservative-treatment-non-BPD subgroup (8.0±1.5, t=6.20, 8.51, both P<0.001). The LUS of early-intervention group and the conservative-treatment-BPD subgroup was significantly higher than those in the conservative-treatment-non-BPD subgroup and the control group (13.2±1.7 vs. 8.0±1.5 vs. 6.4±1.2) (t=8.73, 11.94, both P<0.001). Conclusions: The day-14 LUS has good predictive value for the development of BPD in VLBW infants with concurrent PDA. When the LUS score exceeds 13, attention should be paid to the possible comorbidity of BPD. The finding may serve as a reference for the timing of early TCPC in VLBW infants who have not been weaned from ventilation, in order to reduce the incidence of BPD.