Plasma levels of natriuretic peptides and hemodynamic assessment of patent ductus arteriosus in preterm infants

Abstract

The main purpose of this study was to investigate whether circulating natriuretic peptides in premature infants reflect the hemodynamic significance of a patent ductus arteriosus (PDA). The study comprises 120 examinations in 55 premature infants with a mean gestational age of 27.2 wk and a mean birthweight of 933 g. Based on clinical and echocardiographic findings, the hemodynamic influence of ductal shunting was classified as small, moderate or large. Blood samples for N‐terminal proatrial natriuretic peptide (Nt‐proANP) and brain natriuretic peptide (BNP) were analysed after completion of the clinical part of the study. Linear regression indicated a very strong association between Nt‐proANP and BNP (adjusted R2= 0.89). The mean levels of Nt‐proANP and BNP increased with the size of the shunt through a PDA, and peptide values followed hemodynamic alterations. The size of PDA accounted for 50% and 47% of the total variation in the plasma values of Nt‐proANP and BNP, respectively. In detecting an echocardio‐graphically significant PDA, the area under a ROC curve was 0.94 for Nt‐proANP and 0.90 for BNP. Conclusion: The magnitude of shunting through a PDA is the main determinant of plasma levels of natriuretic peptides in premature infants. Nt‐proANP and BNP seem to have the same pattern of secretion. Our findings indicate that measurements of natriuretic peptides may provide clinically relevant information in the hemodynamic assessment of premature infants.

How useful are B-type natriuretic peptide measurements for monitoring changes in patent ductus arteriosus shunt magnitude?

“…[16][17][18][19][20][21][22] However, despite this significant association, Abbreviations: BNP, B-type natriuretic peptide; PDA, patent ductus arteriosus. Legend: N ¼ 146 BNP-echocardiogram pairs (from 88 infants).…”

“…Other investigators have observed a decrease in BNP concentrations following pharmacological or surgical PDA closure 23,19,21 and have suggested that serial BNP measurements may be used to monitor changes in PDA shunt magnitude. As none of the previous studies reported about either the ability of BNP measurements to detect spontaneously closing PDAs or PDAs that were developing worsening shunts (increasing degrees of shunt magnitude), we examined the accuracy of using serial measurements of BNP to monitor changes in PDA shunt magnitude.…”

“…[12][13][14][15] Numerous studies suggest that elevated BNP concentrations may be useful for detecting the presence of a PDA in premature neonates. [16][17][18][19][20][21][22] Recently, several authors have suggested that by using BNP measurements to monitor changes in PDA shunt magnitude, the need for repeated echocardiography may be obviated. Although BNP concentrations decrease to levels comparable to those in preterm infants without a PDA following successful treatment and elimination of the left-to-right shunt, 23,21 no studies to date have reported on the ability of BNP measurements to detect worsening or increasing degrees of shunt magnitude.…”

Use of cardiac biomarkers in neonatology

“…Associations were found between natriuretic peptide levels and each of the following: ductal size, magnitude of shunting, and left-atrial to aorta root ratio (5,59). BNP levels were found to be correlated with hemodynamic alterations caused by ductal size, constriction, and dilatation (13,20,60). However, because of the high degree of variability, BNP measurements are not clinically useful for predicting changes in shunt magnitude (61).…”

“…When their application in adult medicine was found to show promise, research began to be directed toward the potential use of natriuretic peptides in neonatal medicine. Hölmstrom et al found a strong correlation between BNP and NT-proBNP; therefore both are considered to be useable depending on local availability (13). Because NT-proBNP is excreted primarily by the kidney, its use depends on renal function (14).…”