Urinary NT-proBNP, NGAL, and H-FABP May Predict Hemodynamic Relevance of Patent Ductus Arteriosus in Very Low Birth Weight Infants

Abstract

Background: Hemodynamically significant patent ductus arteriosus (hsPDA) is the most common functional cardiovascular disease in preterm infants. The necessity to treat hsPDA can neither be derived solely from clinical nor from echocardiographic criteria. Objective: The aim of this study was to establish non-invasive parameters which can differentiate hsPDA from non-hsPDA. Methods: Urinary protein levels of NT-proBNP, NGAL, and H-FABP were measured and correlated with the necessity of therapy for PDA. In 37 neonates (<1,500 g), urinary protein concentrations were tested on days 0, 2, and 7 by ELISA methodology. Of 37 infants, 12 required therapeutic interventions according to current treatment standards. Results: Infants receiving an intervention for PDA showed significantly higher levels of pro-BNP, NGAL, and H-FABP at all time points except for NT-proBNP on day 0. Infants requiring a second or third course of ibuprofen had significantly higher levels of H-FABP and NGAL. In all samples, the concentration of the three proteins correlated positively with each other. Conclusions: The present study shows that measurement of urinary proteins is a powerful and non-invasive method to quantify the effect of PDA on systemic perfusion in preterm infants. Furthermore, NGAL and H-FABP may be used to indicate the necessity of pharmacological or surgical treatment of PDA.

Urinary Neutrophil Gelatinase-associated Lipocalin in the evaluation of Patent Ductus Arteriosus and AKI in Very Preterm Neonates: a cohort study

“…Tosse et al found that U-NGAL in neonates with a birth weight below 1,500 g was higher if a PDA that needed either medical or surgical intervention was present than in neonates with no PDA or a PDA with no need for intervention [10]. They diagnosed the PDA by echocardiography on day 1–3 but the need for medical or surgical intervention was based on respiratory setback, oliguria or failure to thrive.…”

“…U-NGAL has been hypothesized to be increased in the presence of a PDA [10]. A shunt across a PDA may result in an unfavorable distribution of the cardiac output between the pulmonary and the systemic circulation.…”

Measurement of Urinary Amino-Terminal Pro-Brain Natriuretic Peptide in Childhood Lower Respiratory Tract Infections: An Indicator of Clinical Severity?

“…NT-ProBNP is also found in the urine as small peptides undergo renal filtration (11). Studies measuring urinary NT-ProBNP levels in children are generally limited to the prediction and follow-up of hemodynamically significant patent ductus arteriosus (hs-PDA) in preterm infants (12,13).…”

Can Early B-Type Natriuretic Peptide Assays Predict Symptomatic Patent Ductus Arteriosus in Extremely Low Birth Weight Infants?

“…Recently, it has been reported that early biological markers were valuable for differentiating hsPDA from insignificant PDA [6,7]. The B-type natriuretic peptide (BNP) is one of the cardiac neurohormones released by the ventricles in response to increased wall stress and volume or pressure overload [8,9].…”