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http://dx.doi.org/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, 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)
Publication Information
Korean Circulation Journal / v.42, no.3, 2012 , pp. 192-196 More about this Journal
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
Patent ductus arteriosus; B-type natriuretic peptide; Echocardiography;
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1 Bancalari E, Claure N, Gonzalez A. Patent ductus arteriosus and respiratory outcome in premature infants. Biol Neonate 2005;88:192-201.   DOI   ScienceOn
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.   DOI
4 Clyman RI. Mechanisms regulating the ductus arteriosus. Biol Neonate 2006;89:330-5.   DOI   ScienceOn
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.   DOI   ScienceOn
6 Kluckow M, Evans N. Ductal shunting, high pulmonary blood flow, and pulmonary hemorrhage. J Pediatr 2000;137:68-72.   DOI   ScienceOn
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.   DOI
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.   DOI   ScienceOn
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.   DOI   ScienceOn
12 Daniels LB, Maisel AS. Natriuretic peptides. J Am Coll Cardiol 2007;50: 2357-68.   DOI   ScienceOn
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.   DOI   ScienceOn
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.   DOI   ScienceOn
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.   DOI   ScienceOn
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.   DOI   ScienceOn
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.   DOI   ScienceOn
19 Skinner J. Diagnosis of patent ductus arteriosus. Semin Neonatol 2001; 6:49-61.   DOI   ScienceOn
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.   DOI   ScienceOn
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.   DOI   ScienceOn
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.   DOI   ScienceOn
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.   DOI   ScienceOn
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.   DOI   ScienceOn
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.   DOI   ScienceOn
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.   DOI   ScienceOn
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.   DOI