Can Early B-Type Natriuretic Peptide Assays Predict Symptomatic Patent Ductus Arteriosus in Extremely Low Birth Weight Infants?

Abstract

Background: Earlier and more accurate identification of a high-risk group of preterm infants that are likely to develop a hemodynamically significant patent ductus arteriosus (hsPDA) would allow specific targeting of early treatment and thus possibly minimize the morbidity and mortality associated with a PDA in extremely low birth weight (ELBW) infants. Objective: To investigate the predictability of B-type natriuretic peptide (BNP) for early targeted treatment of hsPDA in ELBW infants. Methods: 73 ELBW infants that underwent echocardiographic evaluation and plasma BNP measurement after birth were enrolled. 31 infants developed hsPDA (HsPDA group) and 42 infants did not develop hsPDA (nPDA group). Results: BNP levels of the HsPDA group were significantly higher than those of the nPDA group at 24 h of age (921 [318–2,133] vs. 152 [91–450] pg/ml) but not different at 12 h of age. BNP levels at 24 h of age were significantly correlated with the magnitudes of the ductal shunt but not at 12 h of age. The area under the receiver operator characteristic curve of BNP levels for prediction of hsPDA at 24 h of age was 0.830. At the cutoff BNP levels of 200 and 900 pg/ml at 24 h of age, sensitivity was 83.9 and 54.8% and specificity was 61.9 and 95.2%, respectively. Conclusions: BNP levels at 24 h of age can be used as a guide for early targeted treatment of hsPDA and avoid the unnecessary use of cyclooxygenase inhibitors in ELBW infants.

Early Detection of Prenatal Cardiocirculatory Compromise in Small for Gestational Age Infants

“…In this study no difference in PDA occurrence was found. We did find, as did a study by Lee et al [25], early BNP elevation to be related to hsPDA in the AGA group. Although this is an interesting find, it is beyond the scope of this paper.…”

Brain-type natriuretic peptide levels correlate with pulmonary hypertension and requirement for extracorporeal membrane oxygenation in congenital diaphragmatic hernia

“…Serum BNP levels are significantly increased in patients with hemodynamically symptomatic PDA requiring indomethacin administration and/or surgical ligation compared to those with asymptomatic PDA [12]. In this setting, BNP levels may have predictive value in determining those infants likely to develop hemodynamic changes necessitating treatment [13]. BNP levels are also elevated in PPHN [4], with levels correlating with clinical rebound as well as normalization of pulmonary pressures following therapeutic intervention [14].…”

Comparison of the Mortality and In-Hospital Outcomes of Preterm Infants Treated with Ibuprofen for Patent Ductus Arteriosus with or without Clinical Symptoms Attributable to the Patent Ductus Arteriosus at the Time of Ibuprofen Treatment

“…Choi et al (24) suggested that the BNP levels correlated well with the magnitude of the ductal shunt, and the BNP levels were higher in the symptomatic PDA group when compared with the asymptomatic PDA group. Other researchers suggested that the early BNP level was significantly correlated with the magnitude of the ductal shunt and can help to predict hsPDA (2526). Because we could get the BNP level in only 14 infants among the study population (data are not shown), we could not examine such a correlation between the BNP level and other echocardiographic or radiographic parameters or the association between the severity of the clinical symptoms and the BNP level.…”