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NTproBNP is a useful early biomarker of bronchopulmonary dysplasia in very low birth weight infants

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Abstract

Bronchopulmonary dysplasia (BPD) is a severe complication of prematurity that impacts survival and neurodevelopment. Currently, no early marker exists which could help clinicians identify which preterm infants will develop BPD. Given the evidence that NTproBNP is elevated in children with BPD, we hypothesized that it could be used as an early marker of BPD development. We conducted a prospective cohort study including very low birth weight infants (VLBWI) admitted to our NICU between January 2015 and January 2017 in which we determined serial NTproBNP levels on days 1 and 3 and then weekly, until 49 days of life. A total of 101 patients were recruited (mean birth weight 1152 g (SD 247.5), mean gestational age 28.9 weeks (SD 1.9)). NTproBNP levels differed among infants who did and did not develop BPD from 14 to 35 days of life with the greatest difference on day 14 of life (non-BPD group (n = 86): 1155 (IQR 852–1908) pg/mL, BPD (n = 15): 9707 (IQR 3212–29,560) pg/mL; p = 0.0003). The presence of HsPDA did not account for higher levels of NTproBNP at day 14 (p = 0.165). We calculated an optimal cutoff point of 2264 pg/mL at 14 days of life (sensitivity 100%, specificity 86% and AUC 0.93).

Conclusions: NTproBNP at 14 days of life could be used as an early marker of later BPD development in VLBWI.

What is Known:

• Children with BPD have elevated NTproBNP levels, which are related to the severity of BPD and the development of pulmonary hypertension.

What is New:

• NTproBNP at 14 days of life is higher in those who later develop BPD, regardless of the presence of hemodynamically significant patent ductus arteriosus.

• A calculated cutoff point of 2264 pg/mL of NTproBNP at 14 days has a sensitivity of 100% and specificity of 86% in the prediction of BPD.

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Abbreviations

AUC:

Area under the curve

BNP:

Brain natriuretic peptide

BPD:

Bronchopulmonary dysplasia

CRIB:

Clinical risk index for babies

EDTA:

Ethylenediaminetetraacetic acid

GA:

Gestational age

HsPDA:

Hemodynamically significant patent ductus arteriosus

IQR:

Interquartile range

NEC:

Necrotizing enterocolitis

NPV:

Negative predictive value

NTproBNP:

N-terminal pro-brain natriuretic peptide

PDA:

Patent ductus arteriosus

PH:

Pulmonary hypertension

PMA:

Postmenstrual age

PPV:

Positive predictive value

ROC:

Receiver operator curve

ROP:

Retinopathy of prematurity

SD:

Standard deviation

Se:

Sensitivity

Sp:

Specificity

VLBWI:

Very low birth weight infants

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Author information

Authors and Affiliations

  1. Department of Neonatology, Puerta del Mar University Hospital, Avenida Ana de Viya 21, 11009, Cádiz, Spain

    Paula Méndez-Abad, Pamela Zafra-Rodríguez, Simón Lubián-López & Isabel Benavente-Fernández

Authors
  1. Paula Méndez-Abad
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  2. Pamela Zafra-Rodríguez
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  3. Simón Lubián-López
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  4. Isabel Benavente-Fernández
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Contributions

PMA: Concept/design, Data analysis/interpretation, Drafting article, Approval of article, Data collection

PZR: Concept/design, Data analysis/interpretation, Drafting article, Approval of article, Data collection

SLL: Concept/design, Critical revision of article, Approval of article

IBF: Concept/design, Data analysis/interpretation, Critical revision of article, Approval of article, Statistics

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Correspondence to Paula Méndez-Abad.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Communicated by Patrick Van Reempts

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Méndez-Abad, P., Zafra-Rodríguez, P., Lubián-López, S. et al. NTproBNP is a useful early biomarker of bronchopulmonary dysplasia in very low birth weight infants. Eur J Pediatr 178, 755–761 (2019). https://doi.org/10.1007/s00431-019-03347-2

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  • DOI: https://doi.org/10.1007/s00431-019-03347-2

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