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European Journal of Pediatrics

, Volume 173, Issue 11, pp 1491–1496 | Cite as

Serial N-terminal pro-brain natriuretic peptide measurement as a predictor of significant patent ductus arteriosus in preterm infants beyond the first week of life

  • Johannes Buca Letshwiti
  • Jan Sirc
  • Ruth O’Kelly
  • Jan Miletin
Original Article

Abstract

The aim of the study was to assess the role of plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) concentration as a predictor of patent ductus arteriosus (PDA) in very low birth weight infants beyond the first week of life. This was a prospective observational study; newborns with a birth weight < 1500 g were eligible for enrolment. Enrolled infants were screened by echocardiography on day seven of life for the presence of a PDA. This was paired with a blood sample for NT-proBNP level. Echocardiography and NT-proBNP levels were repeated at weekly intervals. The primary outcome was correlation between PDA and NT-proBNP level and between measurements of PDA significance and NT-proBNP. Sixty-nine neonates were enrolled following parental consent. The mean birth weight was 1119 ± 257 g and mean gestational age was 28.6 ± 2.6 weeks. Median NT-proBNP level on day seven was 11469 ng/l in infants with a PDA vs. 898 ng/l in infants without a PDA (p < 0.0001). There was a statistically significant correlation between PDA diameter and NT-proBNP level on day seven, day 14 and day 21.Conclusion: NT-proBNP concentration is significantly increased in infants with a PDA and correlates well with PDA diameter in the first three weeks of life.

Key words

N-terminal pro-brain natriuretic peptide Patent ductus arteriosus Prematurity Very low birth weight infant 

Abbreviations

BPD

bronchopulmonary dysplasia

BNP

B-type natriuretic peptide

ECLIA

Electrochemiluminescence Immunoassay

hsPDA

haemodynamically significant PDA

IVH

intraventricular haemorrhage

LA/Ao

Left Atrium to Aorta ratio

PDA/LPA

PDA to Left Pulmonary Artery ratio

NEC

necrotising enterocolitis

NT-proBNP

N-terminal pro-brain natriuretic peptide

PDA

patent ductus arteriosus

PEEP

positive end expiratory pressure

ROC

receiver operator characteristic

ROP

retinopathy of prematurity

VLBW

very low birth weight

Notes

Conflict of interests

Authors have no conflict of interest. This study was not supported or sponsored by any manufacturer or industrial body.

References

  1. 1.
    Attridge JT, Kaufman DA, Lim DS (2009) B-type natriuretic peptide concentrations to guide treatment of patent ductus arteriosus. Arch Dis Child Fetal Neonatal Ed 94(3):F178–F182. doi: 10.1136/adc.2008.147587 PubMedCrossRefGoogle Scholar
  2. 2.
    Benitz WE (2011) Learning to live with patency of the ductus arteriosus in preterm infants. J Perinatol: official J Calif Perinatal Association 31(Suppl 1):S42–S48. doi: 10.1038/jp.2010.175 CrossRefGoogle Scholar
  3. 3.
    Chen S, Tacy T, Clyman R (2010) How useful are B-type natriuretic peptide measurements for monitoring changes in patent ductus arteriosus shunt magnitude? J Perinatol: official J Calif Perinatal Association 30(12):780–785. doi: 10.1038/jp.2010.47 CrossRefGoogle Scholar
  4. 4.
    Choi BM, Lee KH, Eun BL, Yoo KH, Hong YS, Son CS, Lee JW (2005) Utility of rapid B-type natriuretic peptide assay for diagnosis of symptomatic patent ductus arteriosus in preterm infants. Pediatrics 115(3):e255–e261. doi: 10.1542/peds.2004-1837 PubMedCrossRefGoogle Scholar
  5. 5.
    Costello JM, Goodman DM, Green TP (2006) A review of the natriuretic hormone system's diagnostic and therapeutic potential in critically ill children. Pediatric Critical Care Medicine : J Society of Critical Care Medicine World Federation of Pediatric Intensive and Critical Care Societies 7(4):308–318. doi: 10.1097/01.PCC.0000224998.97784.A3 CrossRefGoogle Scholar
  6. 6.
    Czernik C, Lemmer J, Metze B, Koehne PS, Mueller C, Obladen M (2008) B-type natriuretic peptide to predict ductus intervention in infants <28 weeks. Pediatr Res 64(3):286–290. doi: 10.1203/PDR.0b013e3181799594 PubMedCrossRefGoogle Scholar
  7. 7.
    El-Khuffash A, Higgins M, Walsh K, Molloy EJ (2008) Quantitative assessment of the degree of ductal steal using celiac artery blood flow to left ventricular output ratio in preterm infants. Neonatology 93(3):206–212. doi: 10.1159/000110869 PubMedCrossRefGoogle Scholar
  8. 8.
    El-Khuffash AF, Amoruso M, Culliton M, Molloy EJ (2007) N-terminal pro-B-type natriuretic peptide as a marker of ductal haemodynamic significance in preterm infants: a prospective observational study. Arch Dis Child Fetal Neonatal Ed 92(5):F421–F422. doi: 10.1136/adc.2007.119701 PubMedCrossRefPubMedCentralGoogle Scholar
  9. 9.
    Farombi-Oghuvbu I, Matthews T, Mayne PD, Guerin H, Corcoran JD (2008) N-terminal pro-B-type natriuretic peptide: a measure of significant patent ductus arteriosus. Arch Dis Child Fetal Neonatal Ed 93(4):F257–F260. doi: 10.1136/adc.2007.120691 PubMedCrossRefGoogle Scholar
  10. 10.
    Flynn PA, da Graca RL, Auld PA, Nesin M, Kleinman CS (2005) The use of a bedside assay for plasma B-type natriuretic peptide as a biomarker in the management of patent ductus arteriosus in premature neonates. J Pediatr 147(1):38–42. doi: 10.1016/j.jpeds.2005.03.040 PubMedCrossRefGoogle Scholar
  11. 11.
    Hall C (2004) Essential biochemistry and physiology of (NT-pro)BNP. Eur J Heart Fail 6(3):257–260. doi: 10.1016/j.ejheart.2003.12.015 PubMedCrossRefGoogle Scholar
  12. 12.
    Horbar JD, Carpenter JH, Badger GJ, Kenny MJ, Soll RF, Morrow KA, Buzas JS (2012) Mortality and Neonatal Morbidity Among Infants 501 to 1500 Grams From 2000 to 2009. Pediatrics 129(6):1019–1026. doi: 10.1542/peds.2011-3028 PubMedCrossRefGoogle Scholar
  13. 13.
    Kluckow M, Jeffery M, Gill A, Evans N (2014) A randomised placebo-controlled trial of early treatment of the patent ductus arteriosus. Arch Dis Child Fetal Neonatal Ed 99(2):F99–F104. doi: 10.1136/archdischild-2013-304695 PubMedCrossRefGoogle Scholar
  14. 14.
    McNamara PJ, Sehgal A (2007) Towards rational management of the patent ductus arteriosus: the need for disease staging. Arch Dis Child Fetal Neonatal Ed 92(6):F424–F427. doi: 10.1136/adc.2007.118117 PubMedCrossRefPubMedCentralGoogle Scholar
  15. 15.
    Nuntnarumit P, Khositseth A, Thanomsingh P (2009) N-terminal probrain natriuretic peptide and patent ductus arteriosus in preterm infants. J Perinatol: official J Calif Perinatal Association 29(2):137–142. doi: 10.1038/jp.2008.185 CrossRefGoogle Scholar
  16. 16.
    Ohlsson A, Walia R, Shah SS (2013) Ibuprofen for the treatment of patent ductus arteriosus in preterm and/or low birth weight infants. Cochrane Database Syst Rev 4, CD003481. doi: 10.1002/14651858.CD003481.pub5 PubMedGoogle Scholar
  17. 17.
    Ramakrishnan S, Heung YM, Round J, Morris TP, Collinson P, Williams AF (2009) Early N-terminal pro-brain natriuretic peptide measurements predict clinically significant ductus arteriosus in preterm infants. Acta Paediatr 98(8):1254–1259. doi: 10.1111/j.1651-2227.2009.01315.x PubMedCrossRefGoogle Scholar
  18. 18.
    Ramos FG, Rosenfeld CR, Roy L, Koch J, Ramaciotti C (2010) Echocardiographic predictors of symptomatic patent ductus arteriosus in extremely-low-birth-weight preterm neonates. J Perinatol: official J Calif Perinatal Association 30(8):535–539. doi: 10.1038/jp.2010.14 CrossRefGoogle Scholar
  19. 19.
    Sanjeev S, Pettersen M, Lua J, Thomas R, Shankaran S, L'Ecuyer T (2005) Role of plasma B-type natriuretic peptide in screening for hemodynamically significant patent ductus arteriosus in preterm neonates. J Perinatol: official J Calif Perinatal Association 25(11):709–713. doi: 10.1038/sj.jp.7211383 CrossRefGoogle Scholar
  20. 20.
    Silverman NH, Lewis AB, Heymann MA, Rudolph AM (1974) Echocardiographic assessment of ductus arteriosus shunt in premature infants. Circulation 50(4):821–825PubMedCrossRefGoogle Scholar
  21. 21.
    Skinner J (2000) Ductal shunting. In: Alverson D, Hunter S (eds) Skinner J. Echocardiography for the Neonatologist, Churchill Livingstone, pp 151–167Google Scholar
  22. 22.
    Van Overmeire B, Follens I, Hartmann S, Creten WL, Van Acker KJ (1997) Treatment of patent ductus arteriosus with ibuprofen. Arch Dis Child Fetal Neonatal Ed 76(3):F179–F184PubMedCrossRefPubMedCentralGoogle Scholar
  23. 23.
    Vanhaesebrouck S, Zonnenberg I, Vandervoort P, Bruneel E, Van Hoestenberghe MR, Theyskens C (2007) Conservative treatment for patent ductus arteriosus in the preterm. Arch Dis Child Fetal Neonatal Ed 92(4):F244–F247. doi: 10.1136/adc.2006.104596 PubMedCrossRefPubMedCentralGoogle Scholar
  24. 24.
    Witthaut R (2004) Science review: natriuretic peptides in critical illness. Crit Care 8(5):342–349. doi: 10.1186/cc2890 PubMedCrossRefPubMedCentralGoogle Scholar
  25. 25.
    Zonnenberg I, de Waal K (2012) The definition of a haemodynamic significant duct in randomized controlled trials: a systematic literature review. Acta Paediatr 101(3):247–251. doi: 10.1111/j.1651-2227.2011.02468.x PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Johannes Buca Letshwiti
    • 1
  • Jan Sirc
    • 1
    • 2
  • Ruth O’Kelly
    • 3
  • Jan Miletin
    • 1
    • 2
    • 4
  1. 1.Neonatal Intensive Care UnitCoombe Women and Infants University HospitalDublinIreland
  2. 2.Neonatal Intensive Care UnitInstitute for the Care of Mother and ChildPragueCzech Republic
  3. 3.Biochemistry DepartmentCoombe Women and Infants University HospitalDublinIreland
  4. 4.Department of PaediatricsUCD School of Medicine and Medical SciencesDublinIreland

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