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...
Available online ---Key Words clinical predictive score; hyperbilirubinemia; neonatal Background: Early identification and appropriate follow-up of infants at risk of severe hyperbilirubinemia are part of preventing complications. This study aims to develop the clinical predictive score to predict subsequent severe hyperbilirubinemia in healthy Thai infants. Methods: A case-control study was conducted using medical records of 147 hyperbilirubinemia cases and 147 age-matched controls among healthy late preterm and term Thai newborn infants during January 2015 and December 2016. The routinely measured TcB values at 48e54 hours of age and all predischarge clinical characteristics were collected. Multivariable logistic regression was used to find a clinical prediction model to predict subsequent severe hyperbilirubinemia within 7 days after birth which defined as a postdischarge bilirubin level exceeding the hour-specific recommended threshold for phototherapy by the American Academy of Pediatrics (AAP). Results: The best clinical predictors for subsequent severe hyperbilirubinemia were TcB values at 48e54 hours and gestational age of infants. Predischarge TcB at 48e54 hours of life was classified into 3 levels: < 10 mg/dL, 10e12 mg/dL and > 12 mg/dL. Gestational age was categorized into 5 groups. The risk score derived from these 2 significant factors predicted subsequent severe hyperbilirubinemia with an AuROC curve of 81.0% (95% CI: 76.2e85.9%) in 3 risk group, high, moderate and low. The positive likelihood ratio for subsequent severe hyperbilirubinemia of the high-risk group (score > 5) was 4.53 (95% CI: 2.91e7.04) with specificity of 87.1%. The negative predictive value of low-risk group (score < 3) was 81%. Conclusions: A simple predischarge prediction score using gestational age and TcB values at 48 e54 hours of life was developed. This score classified late preterm and term newborn infants into 3 distinct risk levels and may be useful to identify high-risk infants for outpatient followup of subsequent severe hyperbilirubinemia.
INTRODUCTION:N-terminal pro-brain natriuretic peptide (NT-proBNP) in adults has been reported to be a diagnostic marker of ventricular enlargement and volume overload. However, clinical studies using NTproBNP in premature infants have been very limited. OBJECTIVE: We sought to determine whether plasma NT-proBNP in premature infants can identify hemodynamically significant patent ductus arteriosus (hsPDA) and determine the correlation between serial plasma NT-proBNP level and echocardiographic assessment of PDA. METHODS: Thirty-nine preterm infants underwent clinical and echocardiographic examinations for PDA on days-of-life 2, 4, and 7 and simultaneous blood sampling to measure plasma NT-proBNP concentrations. When Ն2 clinical features of PDA were detected along with left-to-right ductal shunting demonstrated by echocardiogram, hsPDA was diagnosed and the patient treated with indomethacin or ibuprofen. RESULTS: On day 2, the mean NT-proBNP concentration in the hsPDA group (n ϭ 12) was significantly higher than that in the non-hsPDA group (n ϭ 23) (3160.3 Ϯ 3104.9 vs 618.1 Ϯ 490.7 pmol/L; P Յ .05). Eight infants (72%) in the hsPDA group became asymptomatic after an initial course of indomethacin or ibuprofen, and their NT-proBNP levels concomitantly declined. NT-proBNP concentrations were significantly correlated with the magnitudes of the ductal shunt, such as left-atrium/aorta ratio and left-atrium volume index (r ϭ 0.753 and 0.596, respectively). The cutoff of NTproBNP concentration at 1204 pmol/L on day 2 gave the best predictive values for hsPDA with 100% sensitivity, 91% specificity, 86.7% positive predictive value, 100% negative predictive value, and a likelihood ratio of 11.5. CONCLUSIONS: The plasma NT-proBNP level on dayof-life 2 is a sensitive marker for predicting hsPDA in preterm infants. Successful closure of PDA corresponds with a decline in plasma levels of NT-proBNP. PREDICTIVE VALUE OF AMPLITUDE-INTEGRATED ELECTROENCEPHALOGRAPHY ON OUTCOME IN NEONATAL EXTRACORPOREAL MEMBRANE OXYGENATION Submitted by Athina Pappas INTRODUCTION:The early and accurate assessment of cerebral function in neonates who undergo extracorporeal membrane oxygenation (ECMO) may identify high-risk infants who are amenable to neuroprotective strategies or, at least, in need of more detailed neuroimaging and neurodevelopmental follow-up. OBJECTIVE: The specific aims of this study were to assess the clinical utility and long-term predictive value of amplitude-integrated electroencephalography (aEEG) in neonatal ECMO. METHODS: Thirty-four infants who required ECMO for respiratory failure were enrolled in the study prospectively. Serial aEEGs were recorded before, during, and after ECMO and classified by 2 independent interpreters on the basis of background pattern and amplitude criteria. Surviving infants were followed up to 18 to 22 months and assessed with a structured neurologic examination and formal developmental testing by using the Bayley Scales of Infant Development II. The primary outcome was death or neurodevelopmenta...
POS combined with PE improved detection of CRIT.CHD. Routine POS is useful in personnel-limited settings.
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