Background: Earlier and more accurate identification of a high-risk group of preterm infants that are likely to develop a hemodynamically significant patent ductus arteriosus (hsPDA) would allow specific targeting of early treatment and thus possibly minimize the morbidity and mortality associated with a PDA in extremely low birth weight (ELBW) infants. Objective: To investigate the predictability of B-type natriuretic peptide (BNP) for early targeted treatment of hsPDA in ELBW infants. Methods: 73 ELBW infants that underwent echocardiographic evaluation and plasma BNP measurement after birth were enrolled. 31 infants developed hsPDA (HsPDA group) and 42 infants did not develop hsPDA (nPDA group). Results: BNP levels of the HsPDA group were significantly higher than those of the nPDA group at 24 h of age (921 [318–2,133] vs. 152 [91–450] pg/ml) but not different at 12 h of age. BNP levels at 24 h of age were significantly correlated with the magnitudes of the ductal shunt but not at 12 h of age. The area under the receiver operator characteristic curve of BNP levels for prediction of hsPDA at 24 h of age was 0.830. At the cutoff BNP levels of 200 and 900 pg/ml at 24 h of age, sensitivity was 83.9 and 54.8% and specificity was 61.9 and 95.2%, respectively. Conclusions: BNP levels at 24 h of age can be used as a guide for early targeted treatment of hsPDA and avoid the unnecessary use of cyclooxygenase inhibitors in ELBW infants.

Keywords:
B-type natriuretic peptide, Patent ductus arteriosus, Preterm infant, Predictable usefulness
1.
Marshall DD, Kotelchuck M, Young TE, Bose CL, Kruyer L, O’Shea TM: Risk factors for chronic lung disease in the surfactant era: a North Carolina population-based study of very low birth weight infants. North Carolina neonatologists association. Pediatrics 1999;104:1345–1350.
2.
Jhaveri N, Moon-Grady A, Clyman RI: Early surgical ligation versus a conservative approach for management of patent ductus arteriosus that fails to close after indomethacin treatment. J Pediatr 2010;157:381– 387, 387.e1.
3.
Laughon M, Bose C, Benitz WE: Patent ductus arteriosus management. What are the next steps? J Pediatr 2010;157:355–357.
4.
Kwinta P, Rudzinski A, Kruczek P, Kordon Z, Pietrzyk JJ: Can early echocardiographic findings predict patent ductus arteriosus? Neonatology 2009;95:141–148.
5.
Sehgal A, McNamara PJ: Does echocardiography facilitate determination of hemodynamic significance attributable to the ductus arteriosus? Eur J Pediatr 2009;168:907–914.
6.
Tosse V, Pillekamp F, Verde P, Hadzik B, Sabir H, Mayatepek E, Hoehn T: Urinary NT-proBNP, NGAL, and H-FABP may predict hemodynamic relevance of patent ductus arteriosus in very low birth weight infants. Neonatology 2012;101:260–266.
7.
Letzner J, Berger F, Schwabe S, Benzing J, Morgenthaler NG, Bucher HU, Buhrer C, Arlettaz R, Wellmann S: Plasma C-terminal pro-endothelin-1 and the natriuretic pro-peptides NT-proBNP and MR-proANP in very preterm infants with patent ductus arteriosus. Neonatology 2012;101:116–124.
8.
Levin ER, Gardner DG, Samson WK: Natriuretic peptides. N Engl J Med 1998;339:321–328.
9.
Cowie MR, Mendez GF: BNP and congestive heart failure. Prog Cardiovasc Dis 2002;44:293–321.
10.
Choi BM, Lee KH, Eun BL, Yoo KH, Hong YS, Son CS, Lee JW: Utility of rapid B-type natriuretic peptide assay for diagnosis of symptomatic patent ductus arteriosus in preterm infants. Pediatrics 2005;115:e255–e261.
11.
Sanjeev S, Pettersen M, Lua J, Thomas R, Shankaran S, L’Ecuyer T: Role of plasma B-type natriuretic peptide in screening for hemodynamically significant patent ductus arteriosus in preterm neonates. J Perinatol 2005;25:709–713.
12.
Lee HS, Choi WS, Choi BM, Lee KH, Eun BL, Yoo KH, Hong YS, Son CS, Lee JW: Usefulness of B-type natriuretic peptide assay in predicting symptomatic patent ductus arteriosus in preterm infants. J Korean Soc Neonatol 2004;11:44–53.
13.
Czernik C, Lemmer J, Metze B, Koehne PS, Mueller C, Obladen M: B-type natriuretic peptide to predict ductus intervention in infants <28 weeks. Pediatr Res 2008;64:286–290.
14.
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;117:2183–2189.
15.
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.
16.
Chen S, Tacy T, Clyman R: How useful are b-type natriuretic peptide measurements for monitoring changes in patent ductus arteriosus shunt magnitude? J Perinatol 2010;30:780–785.
17.
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.
18.
Mannarino S, Garofoli F, Mongini E, Cerbo RM, Codazzi AC, Tzialla C, Mazzucchelli I, Perotti G, Tinelli C, De Silvestri A, Manzoni P, Stronati M: BNP concentrations and cardiovascular adaptation in preterm and fullterm newborn infants. Early Hum Dev 2010;86:295–298.
© 2012 S. Karger AG, Basel
2012
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.