# Cardiac function in 6-year-old children born extremely preterm and associations to prolonged patent ductus arteriosus shunting

## TL;DR

Extremely preterm children show altered heart function at age 6.5, but prolonged neonatal PDA shunting does not cause major long-term cardiac issues.

## Contribution

This study investigates long-term cardiac effects of prolonged patent ductus arteriosus shunting in extremely preterm children.

## Key findings

- EPT children had smaller heart chambers and altered biventricular function compared to term-born controls.
- Prolonged hsPDA shunting for over 21 days did not lead to major cardiac alterations.
- Early cardiac remodeling is supported as a consequence of extremely preterm birth.

## Abstract

Follow-up studies of extremely preterm born (EPT) individuals have shown reduced cardiac dimensions and altered biventricular function compared with term born controls. A hemodynamically significant patent ductus arteriosus (hsPDA) increases cardiac load during the neonatal period but potential long-term risks associated with prolonged hsPDA shunting are still largely unknown. We aimed to describe cardiac dimensions and functions in EPT children at 6.5 years of age and to investigate if a prolonged neonatal hsPDA shunt would have a negative cardiac impact. In this follow-up study, EPT children underwent repeated neonatal echocardiograms to evaluate PDA shunt duration. At 6.5 years of age, echocardiography was performed for measurements of dimensions and functions and compared with age matched term born controls. Subgroup analyses were made according to neonatal PDA shunt duration. EPT children (n = 57) had significantly smaller heart chambers, a more globe-shaped left ventricle, and signs of altered biventricular systolic function compared with age matched term born controls (n = 63). Children exposed to a hsPDA for > 21 days showed no major cardiac alterations compared with children with shorter shunt duration. Our findings support the theory of early cardiac remodeling following EPT birth. Reassuringly, no major cardiac alterations were seen after a prolonged hsPDA shunt.

The online version contains supplementary material available at 10.1038/s41598-025-34302-x.