B-type natriuretic peptide predicts responses to indomethacin in premature neonates with patent ductus arteriosus.
OBJECTIVE
To determine whether B-type natriuretic peptide (BNP) predicts indomethacin responsiveness in premature neonates with patent ductus arteriosus (PDA).


METHODS
Premature neonates receiving indomethacin for an echocardiograhically large (diameter>1.5 mm) and clinically significant PDA were prospectively studied. All neonates underwent paired echocardiography and BNP measurements at baseline and 24 hours after each dose of indomethacin. After treatment, neonates who responded (with closed or insignificant PDA) and neonates who did not respond (with persistent significant PDA requiring surgical ligation) were compared.


RESULTS
Thirty-one premature neonates (mean gestational age, 30 weeks) underwent 119 paired echocardiography and BNP determinations. Mean BNP levels (1286+/-986 pg/mL) associated with significant PDA (n=96) were higher than those associated with closed or insignificant PDA (n=23; 118+/-124 pg/mL; P<.001). Twenty-three neonates responded and 8 neonates did not respond to indomethacin. Mean baseline BNP levels were higher in neonates who were non-responders (2234+/-991 pg/mL) than neonates who were responders (983+/-814 pg/mL; P=.001). A baseline BNP level>1805 pg/mL had a sensitivity rate of 88% and a specificity rate of 87% for predicting indomethacin non-responsiveness (P=.003).


CONCLUSIONS
High baseline BNP levels predict poor responses to indomethacin and the need for surgery in premature neonates with PDA.
Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
Jong-Hau
JH
Hsu
San-Nan
SN
Yang
Hsiu-Lin
HL
Chen
Hsing-I
HI
Tseng
Zen-Kong
ZK
Dai
Jiunn-Ren
JR
Wu
D002317:Cardiovascular Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D016861:Cyclooxygenase Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D004374:Ductus Arteriosus, Patent / Q000097:blood / Q000000981:diagnostic imaging / Q000188:drug therapy*; D005260:Female; D005865:Gestational Age; D006801:Humans; D007213:Indomethacin / Q000008:administration & dosage / Q000627:therapeutic use*; D007231:Infant, Newborn; D007234:Infant, Premature / Q000097:blood; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011237:Predictive Value of Tests; D011247:Pregnancy; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014463:Ultrasonography
D002317:Cardiovascular Agents; D016861:Cyclooxygenase Inhibitors; D020097:Natriuretic Peptide, Brain; D007213:Indomethacin