Background: B-type natriuretic peptide (BNP) is a marker for ventricular dysfunction secreted as a preprohormone, pro-B-type natriuretic peptide (proBNP), and cleaved into BNP and a biologically inactive fragment, Nterminal pro-B-type natriuretic peptide (NT-proBNP). Little is known about the clinical usefulness of NT-proBNP in preterm infants. Objective: To evaluate the usefulness of plasma NTproBNP in diagnosing haemodynamically significant patent ductus arteriosus (hsPDA) in neonates and examine some factors that might affect this. Methods: Infants born at ,34 weeks' gestational age (GA) and ,2 kg birth weight (BW) were prospectively enrolled within 6-12 hours of birth. Plasma NT-proBNP levels were measured on days 1, 3, 5 and 10 with simultaneous echocardiography done to detect hsPDA and assess ventricular function. Significant PDA was diagnosed by large ductal flow with left to right shunt on colour Doppler, measuring .1.6 mm on two-dimensional echocardiography, along with clinical features of PDA. Results: Forty-nine infants were analysed. Median GA was 30 weeks (range 24-33) and median BW 1220 g (range . Eighteen infants with hsPDA had higher day 3 plasma NT-proBNP values (median 32 907 pg/ml; range 11 396-127 155) (p,0.001) than controls (median 3147 pg/ml; range 521-10 343). Infants who developed sepsis had higher day 10 plasma NTproBNP levels. Area under receiver operator characteristic curve for detection of hsPDA, by day 3 NT-proBNP value, was significant 0.978 (95% CI 0.930 to 1.026). NTproBNP was predictive of hsPDA (sensitivity 100%; specificity 95%) at a cut-off value of 11 395 pg/ml. Conclusion: Plasma NT-proBNP level on day 3 is a good marker for hsPDA in preterm infants. Serial measurements of NT-proBNP may be useful in assessing the clinical course of PDA.B (brain)-type natriuretic peptide (BNP) is synthesised and released almost exclusively by ventricular myocardium in response to pressure or volume overload. BNP acts as a vasodilator and has diuretic and natriuretic properties, suppressing the effects of the renin-angiotensin-aldosterone system. The measurement of plasma BNP levels is used in adult patients in the diagnosis and management of congestive heart failure.1 2 BNP is a highly sensitive prognostic indicator of outcome in patients with ventricular end-diastolic dysfunction. [2][3][4] BNP is synthesised as a pre-prohormone containing 134 amino acids; it is cleaved to proBNP (108 amino acids). ProBNP is further cleaved into the biologically active BNP, which contains 32 amino acids, with a half-life of 20 minutes, and the inactive fragment, N-terminal proBNP (NT-proBNP), 1 which has a longer half-life of 60 minutes. 5BNP and its inactive fragment, NT-proBNP, can be measured rapidly and accurately at the point of care.2 3 A few studies have reported on the application of measuring plasma BNP levels in the neonatal population, 6 7 mainly focusing on its use in the diagnosis of haemodynamically significant patent ductus arteriosus (hsPDA) [7][8][9][10][11] ; little is known abou...

The purpose of this study was to measure serum T4, free T4, TSH, T3, rT3, T4 sulfate, and thyroxine binding globulin at four time points within the first 24 h of life (cord and 1, 7, and 24 h) in infants between 24 and 34 wk gestation. The infants were subdivided into gestational age groups: 24-27 wk (n = 22); 28-30 wk (n = 26); and 31-34 wk (n = 24). The TSH surge in the first hour of postnatal life was markedly attenuated in infants of 24-27 wk gestation [8 compared with 20 (28-30 wk) and 23 mU/liter (31-34 wk)]. T4 levels in the most immature group declined over the first 24 h, whereas levels increased in the more mature groups [mean cord and 24-h levels: 65 and 59 (NS) vs. 70 and 84 (P < 0.002) vs. 98 and 125 (NS) nmol/liter]. Free T4 and T3 showed only small, transient increases in the most immature group and progressively larger and sustained increases in the other gestational groups. rT3 and T4 sulfate levels in cord serum were higher in the most immature infants, and in all groups levels decreased initially and then variably increased. The features of a severely attenuated or failed hypothalamic-pituitary-thyroid response to delivery critically define this 24- to 27-wk group as distinct from more mature preterm infants.

Evaluation of the mechanisms leading to the placental characteristics identified may help to characterise the causal pathway of NE.

Following HIE, children may experience attention, memory, and behavior difficulties which are not always evident at a young age. The adaptive behavior questionnaire may be a useful tool to select children requiring developmental surveillance beyond 2 years of age. What is known: • Diversity of outcome across grades of HIE is reported and few studies have looked at the milder consequences of HIE at school age. What is new: • Following HIE children may experience attention, memory, and behavior difficulties which are not always evident at a young age. • The adaptive behavior questionnaire may be a useful tool to select children requiring developmental surveillance beyond 2 years of age.

A strong association between placenta accreta, placenta praevia and prior Caesarean birth has been demonstrated. As there is the potential for significant maternal morbidity the risk of placenta accreta needs to be recognised and women at risk should be considered for delivery at an institution with appropriate expertise and resources in managing this condition.