Reference values for N-terminal Pro-brain natriuretic peptide in premature infants during their first weeks of life

Abstract

The aim of our study was to observe the temporal distribution of serum N-terminal pro-brain natriuretic peptide (NT-proBNP) in premature infants of ≤ 31 weeks of gestational age (GA) during the first weeks of life. NT-proBNP values of 118 preterm infants born ≤ 31 weeks GA were determined during the first week of life, after 4 ± 1 weeks of life, and at a corrected GA of 36 ± 2 weeks. Infants were divided into two groups: those without relevant complications and those with complications related to prematurity. NT-proBNP values of infants without complications define our exploratory reference values. The Median NT-proBNP level of these infants was 1896 ng/l (n = 27, interquartile range (IQR): 1277–5200) during the first week of life, 463 ng/l (n = 26, IQR: 364–704) at 4 ± 1 weeks of life, and 824 ng/l (n = 33, IQR: 714–1233) at a corrected GA of 36 ± 2 weeks. Infants born < 28 + 0 weeks GA had significantly higher NT-proBNP values (n = 9, median: 5200, IQR: 1750–8972) than infants born ≥ 28 + 0–31 weeks GA (n = 18, median: 1528, IQR: 838–3052; p = 0.017). Growth restriction or PDA status could not account for the difference in NT-proBNP values between GA groups. Conclusions: The results of our observational and cross-sectional study describe exploratory reference values for NT-proBNP levels in preterm infants of ≤ 31 weeks GA according to postnatal age. NT-proBNP levels during the first week of life are high and widely distributed in preterm infants and decrease subsequently to reach a distinctly lower and stable plateau at around 1 month of life. Our results suggest an influence of GA on NT-proBNP values in the first week of life. What is Known:• Several complications related to prematurity, e.g., hemodynamically significant PDA, pulmonary hypertension, bronchopulmonary dysplasia, and retinopathy of prematurity, have been associated with a temporary rise in NT-proBNP values in preterm infants during their first weeks of life.What is New:• This observational study provides reference values for NT-proBNP levels of very and extremely preterm infants during their first weeks of life.• In premature infants without complications, NT-proBNP values during their first week of life depend on gestational age at birth.

Association Between NT-proBNP and Prolonged Length of Stay in Hospital Among Preterm Infants Born at 28–31 Weeks' Gestation

“…N-terminal pro b-type natriuretic peptide (NT-proBNP) is an inactive amino acid fragment of the brain natriuretic peptide (BNP) that is released from cardiomyocytes in response to pressure or volume overload, promoting vasodilation and natriuresis ( 10 ). NT-proBNP level is associated with impaired cardiac function among children and infants and influenced by kidney function ( 11 – 13 ).…”

“…NT-proBNP level is associated with impaired cardiac function among children and infants and influenced by kidney function ( 11 – 13 ). In adults, NT-proBNP has been extensively studied in many domains including cardiac diseases, diabetes, and rheumatoid arthritis ( 10 , 14 ). Several studies found that NT-proBNP was associated with the hospital stay of adult patients with heart diseases ( 15 , 16 ).…”

Can NT-proBNP Levels Be an Early Biomarker of Reduced Left Ventricular Ejection Fraction in Preterm Infants?

“…A previous study had noted that the levels of NT-proBNP were the highest in first days of life in full-term infants and showed a marked decline during the first week life. They noted that the reference values of NT-proBNP in infants and children var across wide ranges, 260-13,224 pg/mL and 28-7250 pg/mL, during days 0-2 and 3-11 life, respectively, and found that the level dropped dramatically after 3 days of life Harris et al and Fritz et al reported a similar phenomenon in preterm infants [8,9]. In t…”

“…They noted that the reference values of NT-proBNP in infants and children varied across wide ranges, 260-13,224 pg/mL and 28-7250 pg/mL, during days 0-2 and 3-11 of life, respectively, and found that the level dropped dramatically after 3 days of life [4]. Harris et al and Fritz et al reported a similar phenomenon in preterm infants [8,9]. In this study, we also found that, in preterm infants without reduced cardiac ejection fraction, the NT-proBNP levels declined gradually after birth.…”

The Trend of Urinary N Terminal Probrain Natriuretic Peptide in Extremely Low Birth Weight Infants during the Neonatal Period

“…They concluded that serum NT-proBNP levels during the first week of life are high and widely distributed in preterm infants and decrease subsequently to reach a distinctly lower and stable plateau at around 1 month of life. 44…”