Early NT-proBNP Is Able to Predict Spontaneous Closure of Patent Ductus Arteriosus in Preterm Neonates, But Not the Need of Its Treatment

Abstract

The objective of this study was to establish the potential utility of N-terminal pro-brain natriuretic peptide (NT-proBNP) in the management of patent ductus arteriosus (PDA). This was a monocentric prospective blind study that was conducted in a referral neonatal intensive care unit. The patients were very low-birth-weight/gestational-age neonates. Babies with cardiac congenital anomaly other than PDA, life-threatening congenital malformation, severe asphyxia at birth, persistent pulmonary hypertension, and death within the first week of life were excluded. Plasma NT-proBNP concentrations were determined on days 2, 4, and 7 of life. Echocardiography was performed on days 4 and 7. Results were blinded to clinicians. Only echographic results were available upon request. Thirty-one infants were included. NT-proBNP levels were significantly correlated to ductal size and to left atrial-to-aortic diameter ratio. The median NT-proBNP on both days 2 and 4 was significantly higher in neonates with later treated or persistent PDA. A level above 10.000 pg/mL at 48 h of age yielded a 100% positive and a 87% negative predictive value to exclude spontaneous ductal closure. However, no NT-proBNP threshold could predict which PDA would be judged necessary to treat. It was concluded that early low NT-proBNP values can be used as a reliable independent marker to predict spontaneous ductal closure in preterm neonates. Yet, high NT-proBNP levels should not be used to guide the decision to treat PDA, the risk being of treating many bystanding PDAs.

Predictive value of blood N-terminal pro-brain natriuretic peptide concentrations for early patent ductus closure in very preterm infants

“…Therefore, high levels of serum NT-proBNP do not allow determining infants that need pharmacological treatment. A similar conclusion was made by Martinovici et al [23] who showed that serum NT-proBNP level below the cutoff of 10,000 pg/ml on the second day of life was associated (89% sensitivity and 100% specificity) with spontaneous DA closure within the first week of life. Yet, any value above this threshold, as a single marker, could not identify neonates who would benefit from targeted PDA treatment [23].…”

“…proBNP value to predict early spontaneous DA closure in very preterm infants with PDA diameter >1.5 mm who were not treated [22,23]. This difference could be explained by the fact that in our study, for the first time the appropriate predictive value of serum NT-proBNP concentrations was evaluated in a randomized group of infants who were managed expectantly.…”

N-terminal pro-brain natriuretic peptide measurementsin hemodynamically significant patent ductus arteriosus in preterm infants

“…Recent studies have showed that the NT-proBNP level on Day-1 of life was affected by gestational age with the level being higher in the more premature infants. 29 …”

N-Terminal Pro-Brain Natriuretic Peptide as a Useful Diagnostic Marker of Acute Kawasaki Disease in Children

“…Infants <1 month of age were also excluded because NTproBNP is extremely high in this group. 10 This study was approved by the hospital ethics committee and written informed consent was obtained from the patients' parents for participation.…”