Objective To examine how different ibuprofen treatment regimens affect the occurrence of bronchopulmonary dysplasia (BPD) in extremely preterm infants with patent ductus arteriosus (PDA). Methods A retrospective case-control study was conducted at the Third Affiliated Hospital of Guangzhou Medical University from September 2017 to December 2019. A total of 230 extremely preterm infants with PDA who met the inclusion criteria were included. The inverse probability of treatment weighting method was applied to evaluate the associations of ibuprofen treatment, the age at treatment initiation, and the total ibuprofen dose in the first course with the risk of BPD. Results Among extremely preterm infants with PDA, the risk of BPD after ibuprofen treatment was 0.326 times that of infants without treatment (OR=0.326, 95%CI: 0.134-0.698). Initiating treatment at an age of ≤2 weeks was associated with a 0.393-fold risk of BPD compared with initiation at >2 weeks (OR=0.393, 95%CI: 0.187-0.800). The use of a high dose (30-50 mg/kg) in the first course of ibuprofen showed no statistically significant association with BPD risk (OR=1.846, 95%CI: 0.903-3.887). Conclusions In extremely preterm infants with PDA, ibuprofen treatment and initiating treatment at an age of ≤2 weeks are protective factors for BPD, while use of a high dose in the first course appears to be unrelated to the risk of BPD.