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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                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200957) 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                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200963). Children exposed to a hsPDA for &gt;\u200921 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.\n                  <\/jats:p>","DOI":"10.1038\/s41598-025-34302-x","type":"journal-article","created":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T01:24:19Z","timestamp":1767921859000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Cardiac function in 6-year-old children born extremely preterm and associations to prolonged patent ductus arteriosus shunting"],"prefix":"10.1038","volume":"16","author":[{"given":"Jonna","family":"Karl\u00e9n","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lilly-Ann","family":"Mohlkert","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna","family":"Gudmundsdottir","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"H\u00e5kan","family":"Eliasson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna-Karin Edstedt","family":"Bonamy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cecilia Pegelow","family":"Halvorsen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2026,1,9]]},"reference":[{"key":"34302_CR1","doi-asserted-by":"publisher","first-page":"713","DOI":"10.1161\/circulationaha.113.002583","volume":"128","author":"AJ Lewandowski","year":"2013","unstructured":"Lewandowski, A. 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