N-terminal pro-B-type natriuretic peptide: a measure of significant patent ductus arteriosus

Abstract

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...

N-terminal probrain natriuretic peptide and patent ductus arteriosus in preterm infants

“…These results were similar to those of the recent study using NT-proBNP on day 3 as a marker for HsPDA in preterm infants. 36 Interestingly, infants in the HsPDA group exhibited only a few clinical signs of PDA, most of which were nonspecific (Table 2). Therefore, the NT-proBNP level on day 2-3 may be used as a screening tool in preterm infants for predicting HsPDA and guiding physicians to consider early echocardiographic evaluation.…”

“…FarombiOghuvbu et al 36 studied serial plasma NT-proBNP levels on day 1, 3, 5 and 10 of life among 49 infants <34 weeks of gestation and found that the plasma NT-proBNP levels on day 3 and day 5, not on day 1 or day 10, were significantly higher in infants with HsPDA. These findings as well as ours suggest that the best timing to measure NT-proBNP level for predicting HsPDA should be at day 2-3 of life.…”

“…High levels of NT-proBNP on day 10 were also found in infants with sepsis. 36 Therefore, high levels of NT-proBNP should be interpreted with caution. In our study, no infants developed clinical sepsis during the first week of life; high levels of NT-proBNP represent an influence of PDA status.…”

Erken doğmuş bebeklerde beyin natriüretik peptit düzeyi ile patent duktus arteriyozus arasındaki ilişki

“…Oghuvbu et al (2) reported in their study that PDA diameter should be 1,6 mm and above for a diagnosis of hemodynamic PDA and as PDA diameter increased, BNP level increased. ElKhuffash et al (5) reported that BNP level was affected by PDA diameter and LA/Ao ratio after the 12 th hour after birth and with the increase in both of these values BNP increased significantly in the review they published about BNP in preterm babies.…”

“…However, supplementary investigations can be beneficial, if clinical findings suggest PDA in centers where ECHO is unavailable. Natriuretic peptide is one of these (2,3). In recent years, use of natriuretic peptide (BNP) as a supplementary investigation in the diagnosis has increased, though not used solely in the diagnosis of PDA.…”