BNP, troponin I, and YKL-40 as screening markers in extremely preterm infants at risk for pulmonary hypertension associated with bronchopulmonary dysplasia

Abstract

Bronchopulmonary dysplasia (BPD) is often complicated by pulmonary hypertension (PH). We investigated three biomarkers potentially suitable as screening markers for extremely preterm infants at risk of BPD-associated PH. In this prospective observational cohort study conducted in a tertiary neonatal intensive care unit, 83 preterm infants with BPD born <28-wk gestation and still inpatients at 36-wk corrected age received an echocardiogram and blood tests of B-type natriuretic peptide (BNP), troponin I, and YKL-40. Infants were analyzed according to echocardiographic evidence of tricuspid regurgitation (TR). Thirty infants had evidence of TR on echocardiogram at 36-wk corrected age. Infants with or without TR had similar baseline demographics: mean ± SD gestational age 26 ± 1 vs. 26 ± 1 wk and birth weight 830 ± 206 vs. 815 ± 187 g, respectively. There was no difference in duration of respiratory support. The right ventricular systolic pressure of infants with evidence of TR was 40 ± 16 mmHg. BNP was the only biomarker that proved to be significantly higher in infants with evidence of TR: median (interquartile range) serum level 54.5 (35-105) vs. 41.5 (30-59) pg/ml, P = 0.043. Subgroup analysis of infants with severe BPD requiring discharge on home oxygen or BPD-related mortality revealed similar results. There was no difference between groups for troponin I and YKL-40. In conclusion, increased serum levels of BNP were associated with evidence of TR at 36-wk corrected gestational age in extremely preterm infants, suggesting a potential role as a screening biomarker for BPD-associated PH.

Serum cardiac troponin elevation predicts mortality in patients with pulmonary hypertension: A meta‐analysis of eight cohort studies

“…The role of cTn elevation as an independent predictor of increased risk of mortality in PH patients remains controversial. In a preclinical study, cTnI levels were not markers of mortality and disease severity in infants with PH . However, our work supported the opposite finding in adults with an age range from 26 to 75.8 years, and a cTnI elevation of 1.1 times successfully predicted all‐cause mortality compared with cTnT.…”

Using clinical and genetic data to predict pulmonary hypertension in bronchopulmonary dysplasia

“…Nitric oxide (NO) metabolites in urine at day of life 3 and decreased citrulline at day of life 7, both have been reported as significant predictors of PH severity at 36 weeks corrected gestational age . Also, in a small cohort of extremely low birth weight infants with BPD‐PH, B‐type natriuretic peptide (BNP) levels were lower in infants that survived, demonstrating potential as a biomarker for mortality in this patient population . Similarly, endostatin (ES): angiopoietin‐1 (Ang‐1) ratio on day of life 7 may also be useful as a biomarker for early PH‐risk prediction in patients with severe BPD .…”

Myocardial Function Maturation in Very-Low-Birth-Weight Infants and Development of Bronchopulmonary Dysplasia

“…However, biochemical biomarkers, such as N-terminal pro B type natriuretic peptide (NTproBNP), have been associated with neonatal morbidities, such as persistent pulmonary hypertension (11) and PDA (12). In infants with BPD, NTproBNP is a suggested marker of pulmonary hypertension (3,13). NTproBNP levels in the first month of life increase in VLBWIs who develop BPD (12,14), as we have previously shown (15), and are related to the degree of BPD (16,17).…”

“…VLBWIs with BPD have increased lengths of hospital stay and greater morbidity and mortality (2). There is an increasing body of research aiming to identify early markers associated with BPD development in VLBWIs that could help identify high-risk infants who would benefit from potential preventive strategies (3,4).…”