Biochemical markers may identify preterm infants with a patent ductus arteriosus at high risk of death or severe intraventricular haemorrhage.
BACKGROUND
A patent ductus arteriosus (PDA) in preterm infants is associated with increased risk of intraventricular haemorrhage (IVH) and death. Cardiac troponin T (cTnT) and N-terminal-pro-B type natriuretic peptide (NTpBNP) are markers of cardiac function and can predict poor outcome in adults.


OBJECTIVE
To determine whether echocardiography and cTnT/NTpBNP levels at 48 h predict death before discharge or severe IVH in preterm infants with a PDA.


METHODS
Infants born <32 weeks' gestation or <1500 g underwent echocardiographic and cTnT/NTpBNP measurements at 12 and 48 h of life. Infants were divided according to their status at discharge: a closed PDA at 48 h, infants with a PDA at 48 h and IVH III/IV and/or death, and infants with a PDA at 48 h without IVH III/IV or death.


RESULTS
Eighty infants with a median gestation of 28 weeks (IQR 26.1-29.5) and birth weight 1.06 kg (0.8-1.21) were included. At 48 h, infants with a PDA and IVH III/IV and/or death had significantly higher median cTnT/NTpBNP levels compared to infants with a PDA without IVH III/IV and/or death and those with spontaneous PDA closure (NTpBNP 9282, 5121 and 740 pmol/l, respectively, p = 0.008, and cTnT 0.66, 0.25 and 0.13 microg/l, respectively, p = 0.027). There were no differences in echocardiographic parameters of PDA size, left atrial to aortic ratio (LA:Ao), left and right ventricular outputs between the PDA groups.


CONCLUSIONS
NTpBNP and cTnT in conjunction with echocardiography may provide a basis for trials of targeted medical treatment in infants with a PDA.
El-Khuffash
A
A
National Maternity Hospital, Holles Street, Dublin, Ireland. afif_faisal@hotmail.com
Barry
D
D
Walsh
K
K
Davis
P G
PG
Molloy
E J
EJ
D015415:Biomarkers / Q000097:blood; D001724:Birth Weight; D002543:Cerebral Hemorrhage / Q000175:diagnosis / Q000209:etiology*; D004374:Ductus Arteriosus, Patent / Q000097:blood / Q000150:complications* / Q000000981:diagnostic imaging; D004812:Epidemiologic Methods; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000097:blood* / Q000000981:diagnostic imaging; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011379:Prognosis; D020107:Troponin T / Q000097:blood*; D014463:Ultrasonography
D015415:Biomarkers; D010446:Peptide Fragments; D020107:Troponin T; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain