N-terminal pro-brain natriuretic peptide as a biomarker for differentiating cardiac and pulmonary disease in term neonates with respiratory distress

Abstract

Objective Brain natriuretic peptide (BNP) is synthesized in the cardiac ventricles and released in response to volume or pressure load. The aim of the study was to determine whether plasma level of N-terminal pro BNP (NT-pro BNP) can distinguish between cardiac and pulmonary disease (PD) among neonates with respiratory distress (RD). Patients and methods The study included 48 term neonates in the first month of life with signs of RD. They were recruited from Neonatal Intensive Care Unit of Al-Galaa Teaching Hospital. Twenty-six healthy neonates were included as a control group. The degree of RD was assessed using Silverman–Anderson score. Chest X-ray, echocardiography, and laboratory measurement of NT-pro BNP were performed. Results According to the underlying disease, neonates with RD were divided into 28 neonates with PD and 20 neonates with congenital heart disease (CHD). Regardless the etiology of RD, NT-pro BNP was significantly higher in the RD group than in the control ( p = 0.001). There was a significant difference between and within the three groups regarding NT-pro BNP ( p = 0.001). NT-pro BNP was significantly higher in the CHD group than in the PD group ( p = 0.001). There was a significant difference between and within RD subgroups. The NT-pro BNP is a very useful test for identification of CHD in neonates with RD. Area under the receiver operating characteristic curve for CHD was 0.857 ( p = 0.01), sensitivity 66%, specificity 85%, and cutoff point was 24.5 pg/mL. The area under the curve for PD was 0.646 ( p = 0.1) with poor sensitivity and specificity, indicating that NT-pro BNP is a poor test for identification of PD in neonates with RD. Conclusion Term neonates with RD have increased plasma levels of NT-pro BNP. NT-pro BNP is a very good test for identification of CHD in neonates with RD, in comparison with PD. Therefore, plasma NT-pro BNP can be used to differentiate between cardiac and pulmonary cause of RD.

N-Terminal Prohormone of Brain Natriuretic Peptide in the Diagnosis and Management of Persistent Pulmonary Hypertension in Newborns

“…Increased pressure in blood vessels and/or myocardial hypoxia induce the synthesis and secretion of BNP. A previous study on 28 newborns with respiratory distress showed that NT-proBNP was much higher in the severe respiratory failure subgroup (26). In the present study, NT-proBNP levels, respiratory failure scores, and inotropic support and oxygen requirements were higher in the severe PPHT group.…”

NT-proBNP Concentrations in the Umbilical Cord and Serum of Term Neonates: A Systematic Review and Meta-Analysis

“…The studies that compose the present review are depicted in Table 2 [ 21 , 26 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 ].…”

“…The next 3 columns show the mean value and the 95% confidence interval. The remaining 2 columns present the fixed model and random model weights [ 21 , 25 , 26 , 41 , 42 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 ]. ( b ) A funnel plot that presents the meta-analysis of NT-proBNP values in healthy term neonates at the bottom.…”

“… ( a ) Biocross evaluation tool for the assessment of the umbilical cord studies [ 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 ]. ( b ) Biocross evaluation tool for the assessment of the serum studies [ 21 , 25 , 26 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 ]. …”

Serum N-Terminal Pro-B-Type Natriuretic Peptide as a Biomarker of Critical Pulmonary Stenosis in Neonates

“…N-terminal pro-B natriuretic peptide (NT-proBNP) is an inactive by-product, which has a longer half-life in circulation and is more stable in serum. At present, NT-proBNP is relevant to various neonatal diseases, such as pulmonary hypertension (6, 7), PDA (8)(9)(10)(11)(12)(13)(14), valular diseases (15), respiratory distress syndrome (16), bronchopulmonary dysplasia (BPD) (7,17,18), and retinopathy of prematurity (19,20). However, limited information is available on the clinical value of NT-proBNP in neonatal PS.…”