Article

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

Department of Pediatrics, Hallym University Sacred Heart Hospital, College of Medicine, Hallym University, Anyang, Korea.
Korean Circulation Journal (Impact Factor: 0.75). 03/2012; 42(3):192-6. DOI: 10.4070/kcj.2012.42.3.192
Source: PubMed

ABSTRACT

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.
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.
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%).
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.

Download full-text

Full-text

Available from: PubMed Central · License: CC BY-NC
  • Source

    Preview · Article · Jan 2013
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Hemodynamically significant patent ductus arteriosus (hsPDA) in preterm infants is a common and important problem associated with significant morbidity and mortality including: intraventricular hemorrhage, necrotizing enterocolitis and bronchopulmonary dysplasia. The rapid and accurate determination of the indications for therapeutic closure of hsPDA in preterm infants is important but often difficult. Currently used tools, such as the clinical findings, including heart failure and the typical echocardiographic features of hsPDA, have unsatisfactory sensitivity and/or specificity. Over the last decade, measurement of plasma B-type natriuretic peptide (BNP) levels using a commercially available bedside testing kit has been proposed to aid in the diagnosis and treatment of hsPDA in preterm infants. The present review analyzes the clinical usefulness of a rapid plasma BNP assay for the management of hsPDA in preterm infants and speculates on potential future therapeutic directions, including predicting subsequent hsPDA for early targeted treatment and predicting of treatment response for decision-making regarding surgical intervention before and after medical treatments.
    Preview · Article · Jan 2013
  • [Show abstract] [Hide abstract]
    ABSTRACT: We studied the incidence, survival, and risk factors for mortality in a cohort of infants for a period of five years, born in two hospitals, one a second-level General Hospital, the second a tertiary perinatal hospital, both in the City of Toluca. The analysis of survival was performed with the Kaplan-Meier method, and Cox regression was used to estimate the risk of death according to different factors. We found an overall incidence of 7.4 per 1,000 live births; in preterm infants, the rate was 35.6 per 1,000, and in term newborns it was 3.68 per 1,000. The most common heart disease was the ductus arteriosus in the overall group and in preterm infants; in term newborns the most common was the atrial septal defect. The specific mortality was 18.64%, follow-up was 579 days, where we found, according to Kaplan-Meier, survival of an average of 437.92 days, with 95% confidence intervals of 393.25 to 482.6 days, with a standard error of 22.79 days; the cumulative probability of survival was 0.741, with a standard error of 0.44. In Cox regression, two variables had a high hazard ratio (HR): these were the presence or absence of cyanosis and the hospital where they were treated as newborns.
    No preview · Article · Nov 2013 · Gaceta medica de Mexico
Show more