Objective This study aimed to identify influence factors of hemodynamically significant patent ductus arteriosus (hsPDA) in very preterm and extremely preterm infants during the early postnatal period. Methods A retrospective analysis of 172 very preterm and extremely preterm infants were conducted from November 2016 to March 2022. Infants were categorized into a PDA closure group (n=83) and a PDA persistence group (n=89), based on the PDA diameter approximately two weeks after birth. Clinical data, including obstetric factors and the infants' conditions at birth, treatment, and complications, were analyzed using univariate and logistic regression methods. Results Univariate analysis indicated that hsPDA was correlated with PDA size, gestational age, birth weight, 1-minute Apgar score, natural conception, prenatal dexamethasone, prenatal magnesium sulfate, maternal gestational diabetes, and premature rupture of membranes (P < 0.05). Logistic regression identified natural conception, prenatal dexamethasone, and magnesium sulfate were helpful for PDA closure, while a large PDA diameter, low birth weight, and maternal gestational diabetes were significant risk factors for hsPDA persistence. Conclusion Clinical predictors can significantly aid in the early recognition of infants at high risk for hsPDA, guiding timely treatment strategies.