Korean Circulation Journal

The Korean Society of Cardiology (대한심장학회)
권호 표지
DOI QR코드

DOI QR Code

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

  • Kim, Joon-Sik (Department of Pediatrics, Hallym University Sacred Heart Hospital, College of Medicine, Hallym University) ;
  • Shim, Eun-Jung (Department of Pediatrics, Hallym University Sacred Heart Hospital, College of Medicine, Hallym University)
  • Published : 2012.03.31
⟨ Previous Next ⟩

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.

Keywords

References

  1. Bancalari E, Claure N, Gonzalez A. Patent ductus arteriosus and respiratory outcome in premature infants. Biol Neonate 2005;88:192-201. https://doi.org/10.1159/000087582
  2. Clyman RI. Ductus arteriosus: current theories of prenatal and postnatal regulation. Semin Perinatol 1987;11:64-71.
  3. Heymann MA, Rudolf AM. Control of the ductus arteriosus. Physiol Rev 1975;55:62-78. https://doi.org/10.1152/physrev.1975.55.1.62
  4. Clyman RI. Mechanisms regulating the ductus arteriosus. Biol Neonate 2006;89:330-5. https://doi.org/10.1159/000092870
  5. Rojas MA, Gonzalez A, Bancalari E, Claure N, Poole C, Silva-Neto G. Changing trends in the epidemiology and pathogenesis of neonatal chronic lung disease. J Pediatr 1995;126:605-10. https://doi.org/10.1016/S0022-3476(95)70362-4
  6. Kluckow M, Evans N. Ductal shunting, high pulmonary blood flow, and pulmonary hemorrhage. J Pediatr 2000;137:68-72. https://doi.org/10.1067/mpd.2000.106569
  7. Hammerman C. Patent ductus arteriosus: clinical relevance of prostaglandins and prostaglandin inhibitors in PDA pathophysiology and treatment. Clin Perinatol 1995;22:457-79.
  8. Cotton RB, Stahlman MT, Kovar I, Catterton WZ. Medical management of small preterm infants with symptomatic patent ductus arteriosus. J Pediatr 1978;92:467-73. https://doi.org/10.1016/S0022-3476(78)80451-X
  9. Walther FJ, Benders MJ, Leighton JO. Persistent pulmonary hypertension in premature neonates with severe respiratory distress syndrome. Pediatrics 1992;90:899-904.
  10. Flynn PA, da Graca RL, Auld PA, Nesin M, Kleinman CS. 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 2005;147:38-42. https://doi.org/10.1016/j.jpeds.2005.03.040
  11. Holmstrom H, Hall C, Thaulow E. Plasma levels of natriuretic peptides and hemodynamic assessment of patent ductus arteriosus in preterm infants. Acta Paediatr 2001;90:184-91. https://doi.org/10.1111/j.1651-2227.2001.tb00282.x
  12. Daniels LB, Maisel AS. Natriuretic peptides. J Am Coll Cardiol 2007;50: 2357-68. https://doi.org/10.1016/j.jacc.2007.09.021
  13. Cantinotti M, Clerico A, Murzi M, Vittorini S, Emdin M. Clinical relevance of measurement of brain natriuretic peptide and N-terminal probrain natriuretic peptide in pediatric cardiology. Clin Chim Acta 2008; 390:12-22. https://doi.org/10.1016/j.cca.2007.12.020
  14. Reynolds EW, Ellington JG, Vranicar M, Bada HS. Brain-type natriuretic peptide in the diagnosis and management of persistent pulmonary hypertension of the newborn. Pediatrics 2004;114:1297-304. https://doi.org/10.1542/peds.2004-0525
  15. Puddy VF, Amirmansour C, Williams AF, Singer DR. Plasma brain natriuretic peptide as a predictor of haemodynamically significant patent ductus arteriosus in preterm infants. Clin Sci (Lond) 2002;103:75-7. https://doi.org/10.1042/CS20020046
  16. Attridge JT, Kaufman DA, Lim DS. B-type natriuretic peptide concentrations to guide treatment of patent ductus arteriosus. Arch Dis Child Fetal Neonatal Ed 2009;94:F178-82.
  17. Evans N. Diagnosis of patent ductus arteriosus in the preterm newborn. Arch Dis Child 1993;68(1 Spec No):58-61. https://doi.org/10.1136/adc.68.1_Spec_No.58
  18. Skelton R, Evans N, Smythe J. A blinded comparison of clinical and echochardiographic evaluation of the preterm infant for patent ductus arteriosus. J Paediatr Child Health 1994;30:406-11. https://doi.org/10.1111/j.1440-1754.1994.tb00689.x
  19. Skinner J. Diagnosis of patent ductus arteriosus. Semin Neonatol 2001; 6:49-61. https://doi.org/10.1053/siny.2000.0037
  20. Tammela O, Ojala R, Iivainen T, et al. Short versus prolonged indomethacin therapy for patent ductus arteriosus in preterm infants. J Pediatr 1999;134:552-7. https://doi.org/10.1016/S0022-3476(99)70239-8
  21. El Hajjar M, Vaksmann G, Rakza T, Kongolo G, Storme L. Severity of the ductal shunt: a comparison of different markers. Arch Dis Child Fetal Neonatal Ed 2005;F90:419-22.
  22. Young TE, Mangum B. Neofax: a Manual of Drugs Used in Neonatal Care. 20th ed. Montvale, NJ: Thompson Healthcare; 2007.
  23. Levin ER, Gardner DG, Samson WK. Natriuretic peptides. N Engl J Med 1998;339:321-8. https://doi.org/10.1056/NEJM199807303390507
  24. Da Graca RL, Hassinger DC, Flynn PA, Sison CP, Nesin M, Auld PA. Longitudinal changes of brain-type natriuretic peptide in preterm neonates. Pediatrics 2006;117;2183-9. https://doi.org/10.1542/peds.2005-1387
  25. Lee HS, Choi WS, Choi BM, et al. Usefulness of B-type natriuretic peptide assay in predicting symptomatic patent ductus arteriosus in preterm infants. J Korean Soc Neonatol 2004;11:44-53.
  26. Choi BM, Lee KH, Eun BL, et al. Utility of rapid B-type natriuretic peptide assay for diagnosis of symptomatic patent ductus arteriosus in preterm infants. Pediatrics 2005;115:e255-61. https://doi.org/10.1542/peds.2004-1837
  27. Hsu JH, Yang SN, Chen HL, Tseng HI, Dai ZK, Wu JR. B-type natriuretic peptide predicts responses to indomethacin in premature neonates with patent ductus arteriosus. J Pediatr 2010;157:79-84. https://doi.org/10.1016/j.jpeds.2009.12.045
  28. Tomaru Ki K, Arai M, Yokoyama T, et al. Transcriptional activation of the BNP gene by lipopolysaccharide is mediated through GATA elements in neonatal rat cardiac myocytes. J Mol Cell Cardiol 2002;34:649-59. https://doi.org/10.1006/jmcc.2002.2005
  29. Ueda S, Nishio K, Akai Y, et al. Prognostic value of increased plasma levels of brain natriuretic peptide in patients with septic shock. Shock 2006;26:134-9. https://doi.org/10.1097/01.shk.0000226266.99960.d0
  30. El-Khuffash A, Molloy EJ. Are B-type natriuretic peptide (BNP) and Nterminal- pro-BNP useful in neonates? Arch Dis Child Fetal Neonatal Ed 2007;92:F320-4. https://doi.org/10.1136/adc.2006.106039

Cited by

  1. Clinical Applications of Plasma B-type Natriuretic Peptide Assays in Preterm Infants with Patent Ductus Arteriosus vol.20, pp.3, 2013, https://doi.org/10.5385/nm.2013.20.3.323
  2. Diagnosing Significant PDA Using Natriuretic Peptides in Preterm Neonates: A Systematic Review vol.135, pp.2, 2012, https://doi.org/10.1542/peds.2014-1995
  3. Brain Natriuretic Peptide: It’s Not About the Brain or Just Another Smart Polypeptide—It’s About the Heart vol.34, pp.6, 2012, https://doi.org/10.1891/0730-0832.34.6.355
  4. The role of n terminal - probrain natriuretic peptide in the diagnosis of hemodynamic persistent asrteriosus ductus in premature neonates patient vol.884, pp.None, 2017, https://doi.org/10.1088/1742-6596/884/1/012147
  5. Effectiveness of B-type Natriuretic Peptide in Caring for Preterm Infants vol.29, pp.2, 2018, https://doi.org/10.14734/pn.2018.29.2.78
  6. The Role of Natriuretic Peptides in Management of Premature Infants with Hemodynamically Significant Patent Arterial Duct vol.18, pp.1, 2019, https://doi.org/10.15690/vsp.v18i1.1987
  7. Early prediction of spontaneous Patent Ductus Arteriosus (PDA) closure and PDA-associated outcomes: a prospective cohort investigation vol.19, pp.1, 2019, https://doi.org/10.1186/s12887-019-1708-z
  8. B-natriuretic peptide serum levels in neonates with persistent pulmonary hypertension vol.69, pp.None, 2012, https://doi.org/10.1186/s43054-021-00058-y
  9. Application of B-Type Natriuretic Peptide in Neonatal Diseases vol.9, pp.None, 2012, https://doi.org/10.3389/fped.2021.767173