B‐type natriuretic peptide for assessment of haemodynamically significant patent ductus arteriosus in premature infants

Abstract

Aim: Haemodynamically significant patent ductus arteriosus (hsPDA) is frequently observed in premature infants. This study was conducted to explore whether the blood BNP can be a valuable biomarker to assess the necessity of treatment for hsPDA in premature infants.Methods: Serial measurements of the blood BNP were performed during the first 5 days of life in premature infants with hsPDA (Group I) and those without hsPDA (Group N). The definition of the hsPDA was the PDA requiring treatment, such as indomethacin administration and/or surgical ligation.Results: Forty-six subjects were enrolled. Compared with Group N, Group I showed significantly higher level of blood BNP at postnatal 24–96 h and demonstrated the peak value at postnatal 24–48 h. With the ROC curve using the data at postnatal 24–48 h in Group I, we deduced the predictive value of 250 pg/mL of blood BNP for indomethacin treatment. Similarly, with the ROC curve using the maximal value of blood BNP within the first 5 days of life, the predictive value of 2000 pg/mL for surgical ligation was deduced.Conclusions: Blood BNP during early postnatal period can be a useful biomarker to assess the necessity of treatment for hsPDA in premature infants.

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

“…In children, BNP levels have been studied in the setting of congenital heart disease [3] and patent ductus arteriosus (PDA) [11], as well as persistent pulmonary hypertension of the newborn (PPHN) [4]. 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].…”

Brain Natriuretic Propeptide as an Early Marker of Bronchopulmonary Dysplasia or Death in the Preterm Newborn

“…The increased pulmonary flow also leads to left heart overload. Thus, the utility of NT-proBNP levels as a biomarker for screening, diagnosis, and monitoring of ductus patency is physiologically explained by the increases occurring in this parameter in situations of hemodynamic overload with stretching of the myocardial wall [5,10,18,21]. In a previous study [19], we found a strong association between HS-PDA and increased NT-proBNP levels, with a specificity of 100 %; that is, patients with an NT-proBNP value above the cutoff level of 9321.5 pg/mL will have HS-PDA [19].…”

“…In all cases, echocardiography was performed by a pediatric cardiologist blinded to the NT-proBNP results at the time of the examination, using an Aloka ProSound Alpha7 system (Hitachi, Tokyo, Japan). The following criteria defined a clinically significant PDA: ductus diameter > 1.5 mm, retrograde diastolic flow in the descending aorta > 30 %, increased left atrial (LA) distension (LA/aorta ratio > 1.4), and transductal Doppler speed < 2 m/s [18]. Management of clinically significant PDA was carried out according to our Neonatal Unit guidelines: medical treatment with ibuprofen (first dose 10 mg/kg, second and third doses 5 mg/kg, separated by 24 h), and surgical ligation for patients in whom medical treatment failed or was contraindicated [13,22].…”

“…Brain natriuretic peptide and Nterminal pro-B type natriuretic peptide (NT-proBNP) levels increase in situations of systolic and diastolic heart failure, as the main stimulus for their secretion is stretching of the myocardial wall by volume overload [12]. Several recent studies have described an association between NT-proBNP levels and ductus patency, and a possible influence of ductus patency on the development of BPD [5,10,16,18,19,21]. One study has investigated whether NT-proBNP might be a useful marker of BPD in preterm neonates.…”

The Role of Natriuretic Peptides in Management of Premature Infants with Hemodynamically Significant Patent Arterial Duct

“…показали (31 недоношенный, средний гестационный возраст 30 нед), что при превышении уровня BNP > 1805 пг/мл медикаментозное лечение ГЗФАП является неэффективным и требуется последующее хирургическое лечение [43]. Рефрактерность к медикаментозному закрытию ГЗФАП установлена и при увеличении BNP > 2000 пг/мл (46 недоношенных, гестационный возраст < 33 нед, масса тела < 1500 г) [44]. Кроме того, отмечено, что лигирование ГЗФАП при высоких значениях BNP позволяет уменьшить количество курсов НПВП у таких пациентов и способствует снижению числа осложнений, связанных с терапией НПВП [44].…”