Korean Circ J.  2012 Mar;42(3):192-196. 10.4070/kcj.2012.42.3.192.

B-Type Natriuretic Peptide Assay for the Diagnosis and Prognosis of Patent Ductus Arteriosus in Preterm Infants

• Kim JS
• Shim EJ

• KMID: 2225033
• DOI: http://doi.org/10.4070/kcj.2012.42.3.192

Abstract

BACKGROUND AND OBJECTIVES
Patent ductus arteriosus (PDA) is a significant cause of morbidity and mortality in preterm infants. Measurement of plasma B-type natriuretic peptide (BNP) has been reported to be a useful bedside screening tool for the presence of hemodynamically significant PDA (hsPDA) in neonates. This study was conducted to investigate the usefulness of a BNP assay as a biochemical marker for the diagnosis of hsPDA and predictive biomarker of the response to indomethacin in preterm infants.
SUBJECTS AND METHODS
Preterm infants born at <37 weeks' gestational age were prospectively enrolled within 24 hours of birth. Plasma BNP levels were measured on days 1, 4, and 7. Significant PDA was diagnosed by large ductal flow with left to right shunt on color Doppler echocardiography, along with clinical features of PDA. Following that, hsPDA was treated with indomethacin.
RESULTS
A total of 28 preterm infants were prospectively enrolled in this study. Seven infants with PDA had higher on day 4 plasma BNP values (median 654.68 pg/mL; range 428.29-1280.00) compared to the control group (median 124.52 pg/mL; range 37.21-290.49). The area under the receiver operator characteristic curve for the detection of hsPDA was high: 0.998 (95% confidence interval: 0.995-1.002). The cutoff of BNP concentration for the diagnosis of hsPDA was determined to be 412 pg/mL (sensitivity: 100%; specificity: 95%).
CONCLUSION
B-type natriuretic peptide can be a useful biomarker for the screening and diagnosis of PDA in preterm infants. Serial BNP measurements are valuable for assessing the clinical course and indomethacin responsiveness of PDA.

Keyword

Patent ductus arteriosus; B-type natriuretic peptide; Echocardiography

MeSH Terms

Biomarkers
Ductus Arteriosus, Patent
Echocardiography
Echocardiography, Doppler, Color
Gestational Age
Humans
Indomethacin
Infant
Infant, Newborn
Infant, Premature
Mass Screening
Natriuretic Peptide, Brain
Parturition
Plasma
Prognosis
Prospective Studies
Indomethacin
Natriuretic Peptide, Brain

Figure

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  Fig. 1 Plasma B-type natriuretic peptide (BNP) values on days 1, 4 and 7 of life. PDA: patent ductus arteriosus.

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  Fig. 2 Correlation between LA/AO ratio and BNP level. BNP levels correlated positively with the LA/AO ratio (r=0.812; p< 0.001). BNP: B-type natriuretic peptide. LA: left atrium, AO: aorta.

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  Fig. 3 Receiver operator characteristic curve determines the B-type natriuretic peptide cutoff value for detecting hemodynamically significant patent ductus arteriosus in preterm infants.

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