Impact of pulmonary hypertension on long-term neurodevelopmental outcomes in preterm neonates with bronchopulmonary dysplasia: A meta-analysis

Abstract

Objective: To systematically evaluate the association between pulmonary hypertension (PH) and long-term neurodevelopmental outcomes in preterm infants with bronchopulmonary dysplasia (BPD).

Methodology: A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. PubMed, Embase, Web of Science, and Scopus were searched from inception to January 28, 2026 for observational studies comparing preterm infants with BPD with and without PH and reporting neurodevelopmental outcomes assessed beyond 12 months of corrected age. Random-effects meta-analyses were performed for continuous outcomes (cognitive, language, and motor scores; standardized mean difference [SMD]) and dichotomous adverse neurodevelopmental outcomes (odds ratio [OR]).

Results: Seven studies were included. Four studies contributed continuous outcome data. PH was associated with significantly lower cognitive (SMD −0.47, 95% CI −0.81 to −0.14), language (SMD −0.28, 95% CI −0.50 to −0.05), and motor scores (SMD −0.50, 95% CI −0.73 to −0.28). Heterogeneity for continuous outcomes was low (I² = 0%). Five studies provided extractable dichotomous data, demonstrating that PH was associated with a higher risk of adverse neurodevelopmental outcomes (OR 2.80, 95% CI 1.57–4.98), with moderate heterogeneity (I² = 48.8%).

Conclusions: PH in preterm infants with BPD may be associated with poorer long-term neurodevelopmental outcomes. Further studies are needed to improve the evidence.