N-terminal-pro-B type natriuretic peptide as a useful tool to evaluate pulmonary hypertension and cardiac function in CDH infants.
OBJECTIVE
In congenital diaphragmatic hernia (CDH) the severity of pulmonary hypertension (PH) is considered, by several authors, determinant of clinical outcome. Plasmatic N-terminal-pro-B type natriuretic peptide (NT-proBNP) might be useful in diagnosis and management of PH in newborns, although its interest in CDH infants remains to be defined. Early NT-proBNP levels were assessed in CDH infants and correlated with cardiovascular echocardiographic parameters.


METHODS
28 newborns, CDH and age-matched controls were enrolled in a prospective study. Clinical condition, NT-proBNP plasmatic levels, echo parameters of PH and biventricular function were assessed at 24 h after delivery as well as survival outcome.


RESULTS
Estimated mean pulmonary pressure and NT-proBNP were significantly higher in CDH than control infants. NT-proBNP significantly correlated with estimated pulmonary artery pressure, right ventricular Tei index, and tricuspid E/A ratio. Additionally, we found that CDH infants with NT-proBNP >11,500 pg/ml experienced a worse prognosis.


CONCLUSIONS
We demonstrated that PH is associated with NT-proBNP elevation and diastolic impairment in CDH infants. Early elevations in NT-proBNP levels seem to alert for a subset of CDH infants with worse prognosis.
Baptista
Maria J
MJ
Divisions of Pediatric Cardiology, Neonatology and Pediatric Surgery, Department of Pediatrics, Hospital S. João, Porto, Portugal. mjb@ecsaude.uminho.pt
Rocha
Gustavo
G
Clemente
Fátima
F
Azevedo
Luís F
LF
Tibboel
Dick
D
Leite-Moreira
Adelino F
AF
Guimarães
Hercília
H
Areias
José C
JC
Correia-Pinto
Jorge
J
D001794:Blood Pressure / Q000502:physiology; D016022:Case-Control Studies; D004452:Echocardiography; D005260:Female; D006321:Heart / Q000503:physiopathology*; D006548:Hernia, Diaphragmatic / Q000097:blood / Q000503:physiopathology*; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D006976:Hypertension, Pulmonary / Q000097:blood* / Q000175:diagnosis* / Q000503:physiopathology; D007231:Infant, Newborn; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011379:Prognosis; D011446:Prospective Studies; D012720:Severity of Illness Index
D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain