Increased risk of bronchopulmonary dysplasia in infants with patent ductus arteriosus**

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    One of the most notable examples is the controversy around the management of PDA in preterm infants. PDAs in extremely preterm infants have been associated with – but not proven to cause - numerous adverse outcomes, including prolongation of assisted ventilation and pulmonary hemorrhage, CLD, NEC, IVH and death [24–28]. The mainstay of PDA treatment, cyclo-oxygenase inhibitors such as indomethacin and ibuprofen, are also associated with adverse outcomes such NEC, gastrointestinal perforation and renal failure [16,29].

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    A PDA associated with clinical or echocardiographic signs of pulmonary hyperperfusion and systemic hypoperfusion is referred to as a hemodynamically significant PDA (hs-PDA). A persistent hs-PDA has been associated with numerous adverse outcomes, including higher rates of death,5 bronchopulmonary dysplasia (BPD),6 necrotizing enterocolitis (NEC),7 renal failure,4 intraventricular hemorrhage (IVH),8 periventricular leukomalacia,9 and cerebral palsy.10 A definitive causal link between these associations has not, however, been demonstrated.11

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Preparation of the data for this report was aided by the efforts of Ms. Paula Langone, R.N. and Ms. Kathleen Finn, R.N.

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