Diagnosing Significant PDA Using Natriuretic Peptides in Preterm Neonates: A Systematic Review

Kulkarni, Madhulika; Gokulakrishnan, Ganga; Price, Jack F.; Fernandes, Caraciolo J.; Leeflang, Mariska; Pammi, Mohan

doi:10.1542/peds.2014-1995

Cited by 69 publications

(67 citation statements)

References 81 publications

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“…NT-proBNP is also elevated in children with congenital heart disease, especially in left-right shunting lesions where it correlates with pulmonary arterial pressure [9]. In prematurely born infants, BNP has been suggested as a marker for a hemodynamically significant PDA [10]. In our study, 8 infants had a PDA, but NT-proBNP levels were not significantly different between the infants with or without a PDA (data not shown), suggesting that these levels were indeed hemodynamically insignificant.…”

Section: Discussionmentioning

confidence: 99%

Biochemical Screening for Pulmonary Hypertension in Preterm Infants with Bronchopulmonary Dysplasia

et al. 2016

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Background: Pulmonary hypertension (PH) in infants with bronchopulmonary dysplasia (BPD) is associated with increased morbidity and mortality. Elevated levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and decreased levels of amino acid precursors of nitric oxide (NO) have been associated with PH, but have not been studied in infants with PH secondary to BPD. Objective: The aim of this study was to identify a biochemical marker for PH in infants with BPD. Methods: Twenty infants, born at <27 weeks' gestational age (GA) and/or with a birth weight (BW) ≤750 g, who met the criteria for BPD at 36 weeks' corrected GA (CGA) were enrolled in this cross-sectional pilot study. A screening echocardiogram was conducted at 36-38 weeks' CGA and plasma NT-proBNP and amino acid levels were obtained within 1 week of the screening echocardiogram. Results: Five infants (25%) had echocardiographic evidence of PH. GA and BW were not significantly different between the 2 groups (a PH group and a No PH group). NT-proBNP was significantly elevated in the PH group (median 1,650 vs. 520 pg/ml; p = 0.001) but citrulline levels were significantly lower (median 21 vs. 36 μmol/l; p = 0.005). Arginine levels were not significantly different between the groups (median 78 vs. 79 μmol/l; p = 1). Conclusion: NT-proBNP and the NO precursor citrulline may be cost-effective biochemical markers for screening for the presence of PH in preterm infants who have BPD. If validated in a larger study, such biochemical markers may, in part, replace PH screening echocardiograms in these patients.

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Section: Discussionmentioning

confidence: 99%

Biochemical Screening for Pulmonary Hypertension in Preterm Infants with Bronchopulmonary Dysplasia

et al. 2016

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“…Plasma BNP, emerging as a sensitive and specific biomarker of sPDA, rapidly decreases in infants as a response to cyclooxygenase inhibitors for ductal closure91014). Attridge et al15) reported that BNP levels can be used as a guide for the treatment of PDA and BNP-guided treatment reduces the number of indomethacin doses during the first course of treatment without any changes in the rate of PDA closure or complications.…”

Section: Discussionmentioning

confidence: 99%

“…A recent systematic review evaluating the diagnostic accuracy of BNP for hemodynamically significant PDA (hsPDA) suggests that plasma BNP measurement seems to be an accurate test for identifying hsPDA in preterm infants10).…”

Section: Introductionmentioning

confidence: 99%

Individualized ibuprofen treatment using serial B-type natriuretic peptide measurement for symptomatic patent ductus arteriosus in very preterm infants

Shin

Lee

et al. 2017

Korean J Pediatr

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PurposePlasma level of B-type natriuretic peptide (BNP), an emerging, sensitive, and specific biomarker of hemodynamically significant patent ductus arteriosus (PDA), rapidly decreases in infants receiving cyclooxygenase inhibitors for ductal closure. We investigated the usefulness of serial BNP measurement as a guide for individual identification of early constrictive responses to ibuprofen in preterm infants with symptomatic PDA (sPDA).MethodsBefore March 2010, the standard course of pharmacological treatment was initiated with indomethacin (or ibuprofen) and routinely followed by 2 additional doses at intervals of 24 hours. After April 2010, individualized pharmacological treatment was used, starting with the first dose of ibuprofen and withholding additional ibuprofen doses if the BNP concentration was <600 pg/mL and clinical symptoms of PDA improved.ResultsThe BNP-guided group received significantly fewer doses of ibuprofen than the standard group did during the first course of treatment and the entire study period. The need for further doses of cyclooxygenase inhibitors and for surgical ligation was not significantly different between the 2 groups. No significant differences were seen in clinical outcomes and/or complications related to sPDA and/or pharmacological treatment.ConclusionIndividualized BNP-guided pharmacological treatment may be used clinically to avoid unnecessary doses of cyclooxygenase inhibitors without increasing the ductal closure failure and the short-term morbidity related to sPDA.

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“…One such marker may be N‐terminal probrain natriuretic peptide (NT‐proBNP), which is emerging in clinical use for the diagnosis of hsPDA. A recent meta‐analysis found NT‐proBNP to be a more sensitive, but less specific marker for hsPDA than brain natriuretic peptide, a similar marker of atrial dilatation that has been used as a biomarker for cardiac dysfunction due to PDA . NT‐proBNP has been shown to have good correlation with flow patterns on echocardiography that are associated with hemodynamic significance of the PDA .…”

Section: Hemodynamically Significant Pda and Bpdmentioning

confidence: 99%

Hemodynamically significant patent ductus arteriosus and the development of bronchopulmonary dysplasia

Willis

Weems

2018

Congenital Heart Disease

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Patent ductus arteriosus (PDA) is prevalent in premature newborns and has been linked to the development of bronchopulmonary dysplasia (BPD), a serious pulmonary complication of premature birth. Although a causal relationship has not been proven, the link is greatest among infants born at lower gestational age who are treated with mechanical ventilation in the presence of a large ductal shunt. Despite strong association in epidemiological studies, treatment of a patent ductus arteriosus has not been shown to prevent BPD, and some therapies may increase the risk of BPD. We describe preclinical and clinical data demonstrating the association of a PDA with BPD, highlight the effects of surgical and pharmacological treatment, and explore the implications of recent clinical trials for the management of PDA in the premature newborn.

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Diagnosing Significant PDA Using Natriuretic Peptides in Preterm Neonates: A Systematic Review

Cited by 69 publications

References 81 publications

Biochemical Screening for Pulmonary Hypertension in Preterm Infants with Bronchopulmonary Dysplasia

Biochemical Screening for Pulmonary Hypertension in Preterm Infants with Bronchopulmonary Dysplasia

Individualized ibuprofen treatment using serial B-type natriuretic peptide measurement for symptomatic patent ductus arteriosus in very preterm infants

Hemodynamically significant patent ductus arteriosus and the development of bronchopulmonary dysplasia

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