Plasma Concentrations of Aminoterminal Pro Atrial Natriuretic Peptide and Aminoterminal Pro Brain Natriuretic Peptide in Healthy Neonates: Marked and Rapid Increase After Birth

Mir, Thomas S.; Laux, Reinhard; Hellwege, H. H.; Liedke, Bozena; Heinze, Cornelius; Buelow, Helmut von; Läer, Stephanie; Weil, Jochen

doi:10.1542/peds.112.4.896

Cited by 136 publications

(84 citation statements)

References 25 publications

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“…This data is supported by the work of Hammerer-Lercher et al and Bakker et al [8,9] who showed NT-proBNP to be significantly higher in plasma from cord blood than in maternal plasma. N values in previous studies have been far too small to reliably define reference intervals for males and females at each age group [8][9][10][11][12][13]. Our data differs from that reported by Rauh et al [13] and Koch et al [26].…”

Section: Discussioncontrasting

confidence: 94%

“…Renal function has also been shown to influence the optimal cut-off points of NT-proBNP and BNP for the diagnosis of cardiacrelated dyspnoea [5]. Adult reference intervals are available in the literature [6,7] and recently Hammerer-Lercher et al and Bekker et al [8,9] [10][11][12][13]. All these studies have been performed on very small numbers of children at any one age group.…”

Section: Introductionmentioning

confidence: 99%

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Pediatric brain natriuretic peptide and N-terminal pro-brain natriuretic peptide reference intervals

Soldin

Boyajian

et al. 2006

Clinica Chimica Acta

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Background-Brain natriuretic peptide (BNP) and N-terminal pro-brain natriuretic peptide (NTproBNP) have been shown to be useful biomarkers for the diagnosis of heart failure. Pediatric reference intervals for these analytes have been reported in part. Previous studies lack large numbers in each group, have not covered all age ranges and have not compared results for BNP with NT-proBNP in simultaneously drawn samples.Methods-We measured BNP in whole blood using the Biosite Triage point-of-care method and plasma NT-proBNP using the Dade RxL Dimension. We assessed between and within-day precision of both methods and after removing outliers employed the Hoffmann approach to calculate pediatric reference intervals over the age range of 0-21 y. We also compared the 2 methods on simultaneously drawn samples.Results-Reference intervals revealed approximately 20-fold higher 97.5th percentiles for neonates than for children >3 y of age. 97.5th percentiles decreased significantly over the first 3 years of life. As shown by others, the CVs for the automated Dade RxL platform were somewhat lower than those for the POCT method. BNP and NT-proBNP correlated well in simultaneously drawn samples (r =0.947).Discussion-Reference intervals for BNP and NT-proBNP are far higher in neonates and infants than in children older than three years of age. The reasons for this are unknown but resemble the elevated CK-MBs and troponins also found in neonates, although the 97.5th percentiles for these latter 2 cardiac markers decrease more rapidly to values found in older children by 6 months of age.

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Section: Discussioncontrasting

confidence: 94%

Section: Introductionmentioning

confidence: 99%

Pediatric brain natriuretic peptide and N-terminal pro-brain natriuretic peptide reference intervals

Soldin

Boyajian

et al. 2006

Clinica Chimica Acta

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“…[20][21][22][23] Studies in adults have shown that NT-proBNP is a more sensitive and more specific marker for ventricular dysfunction than the biologically active BNP. 24,25 Previous studies in healthy full-term infants showed that the plasma BNP level rapidly rises after birth, reaching its peak at day 2-3 of life [26][27][28] and a high plasma BNP level correlates with HsPDA. A decline of BNP level is noted after PDA is closed by indomethacin.…”

Section: Introductionmentioning

confidence: 99%

N-terminal probrain natriuretic peptide and patent ductus arteriosus in preterm infants

Nuntnarumit

Khositseth

2008

J Perinatol

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Objective: To determine whether plasma N-terminal probrain natriuretic peptide (NT-proBNP) in premature infants could identify hemodynamically significant patent ductus arteriosus (HsPDA) and to determine the correlation between serial plasma NT-proBNP and echocardiographic assessment of ductal shunting.Study Design: An observational study involving 35 preterm infants who underwent echocardiographic assessment for PDA on day 2, 4 and 7 of life with simultaneous blood sampling for determination of NT-proBNP concentrations. HsPDA was diagnosed by left-to-right ductal shunt on color Doppler, measuring diameter >1.5 mm on two-dimensional echocardiography plus X2 clinical features of PDA.Result: Plasma NT-proNBP levels on day 2 in the HsPDA group (n ¼ 12) were significantly higher than in non-HsPDA group (n ¼ 23) with a median of 16 353 pg ml À1 (interquartile range (IQR), 12 360-33 459; range, 10 316-104 998) vs 3914 pg ml À1 (IQR, 2601-5782; range, 1535-19 516) (P<0.001), respectively. Eight infants (67%) in the HsPDA group responded to an initial course of indomethacin or ibuprofen and their NT-proBNP levels significantly decreased within 48 h after treatment compared with non-responders (P ¼ 0.007). NT-proBNP concentrations were significantly correlated with left atrial to aortic root ratio. A cut-off NT-proBNP on day 2 of 10 180 pg ml À1 offered the best predictive values for HsPDA with a sensitivity of 100% and a specificity of 91%.Conclusion: Plasma NT-proBNP on day 2 was found as a sensitive marker for predicting HsPDA in preterm infants. Successful closure of PDA was also correspondent with the decline in plasma NT-proBNP. Journal of Perinatology (2009) 29, 137-142; doi:10.1038/jp.2008 published online 20 November 2008 Keywords: preterm infant; patent ductus arteriosus; NT-proBNP Introduction It is of vital importance to recognize and properly treat hemodynamically significant patent ductus arteriosus (HsPDA) in preterm infants. PDA has been reported to be associated with morbidities in preterm infants as a result of ductal steal from systemic circulation, for example, pulmonary congestion, pulmonary hemorrhage, bronchopulmonary dysplasia, intraventricular hemorrhage and necrotizing enterocolitis. [1][2][3][4] Strategies for PDA closure involve prophylactic treatment, presymptomatic treatment for non-HsPDA, and treatment for HsPDA. 5,6 Although prophylactic treatment with indomethacin reduces incidence of PDA and severe intraventricular hemorrhage in preterm infants, 7,8 there are no differences in mortality and long-term neurodevelopment. 9,10 Recent studies have shown that only one-third of very low birth weight infants develops significant PDA. 10,11 Therefore, a number of infants, whose PDA would otherwise close spontaneously, will be exposed to the treatment unnecessarily if prophylaxis strategy is used. Clinical assessment for the diagnosis of PDA has been shown to be specific, but not sensitive. [12][13][14] Echocardiography is used to detect PDA and to assess the degree of shunting through vario...

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“…Efforts have been made to provide normative values for term and preterm infants (6,15). BNP and NT-proBNP concentrations rise at birth in normal healthy infants, level off at 3-4 d, and then fall steadily to stable but low levels in infancy (12,16). In several studies, the method of delivery of the newborn did not influence natriuretic peptide levels (17,18).…”

Section: Natriuretic Peptidesmentioning

confidence: 94%

“…These properties make natriuretic peptides attractive in the identification of congestive heart failure. Given that the serum half-life of BNP is longer than that of ANP, and that the former more accurately reflects cardiac function, BNP or the inactive N-terminal fragment of BNP (NT-proBNP) is generally preferred as a cardiac biomarker (11,12). When their application in adult medicine was found to show promise, research began to be directed toward the potential use of natriuretic peptides in neonatal medicine.…”

Section: Natriuretic Peptidesmentioning

confidence: 99%

Use of cardiac biomarkers in neonatology

et al. 2012

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Plasma Concentrations of Aminoterminal Pro Atrial Natriuretic Peptide and Aminoterminal Pro Brain Natriuretic Peptide in Healthy Neonates: Marked and Rapid Increase After Birth

Abstract: The N-ANP and N-BNP plasma concentrations in healthy neonates showed a marked increase during the first days of age, suggesting that ANP and BNP have physiologic roles in the perinatal circulatory change from fetus to neonate.

Cited by 136 publications

References 25 publications

Pediatric brain natriuretic peptide and N-terminal pro-brain natriuretic peptide reference intervals

Pediatric brain natriuretic peptide and N-terminal pro-brain natriuretic peptide reference intervals

N-terminal probrain natriuretic peptide and patent ductus arteriosus in preterm infants

Use of cardiac biomarkers in neonatology

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