title: Early NT-proBNP is able to predict spontaneous closure of patent ductus arteriosus in preterm neonates, but not the need of its treatment.
abstract: The objective of this study was to establish the potential utility of N-terminal pro-brain natriuretic peptide (NT-proBNP) in the management of patent ductus arteriosus (PDA). This was a monocentric prospective blind study that was conducted in a referral neonatal intensive care unit. The patients were very low-birth-weight/gestational-age neonates. Babies with cardiac congenital anomaly other than PDA, life-threatening congenital malformation, severe asphyxia at birth, persistent pulmonary hypertension, and death within the first week of life were excluded. Plasma NT-proBNP concentrations were determined on days 2, 4, and 7 of life. Echocardiography was performed on days 4 and 7. Results were blinded to clinicians. Only echographic results were available upon request. Thirty-one infants were included. NT-proBNP levels were significantly correlated to ductal size and to left atrial-to-aortic diameter ratio. The median NT-proBNP on both days 2 and 4 was significantly higher in neonates with later treated or persistent PDA. A level above 10.000 pg/mL at 48 h of age yielded a 100% positive and a 87% negative predictive value to exclude spontaneous ductal closure. However, no NT-proBNP threshold could predict which PDA would be judged necessary to treat. It was concluded that early low NT-proBNP values can be used as a reliable independent marker to predict spontaneous ductal closure in preterm neonates. Yet, high NT-proBNP levels should not be used to guide the decision to treat PDA, the risk being of treating many bystanding PDAs.
authors.affiliation: Neonatal Intensive Care Unit, ULB-Erasme Hospital, 808 Route de Lennik, 1070 Brussels, Belgium. danamartinovici@yahoo.com
authors.forename: D
authors.initials: D
authors.lastname: Martinovici
authors.forename: S
authors.initials: S
authors.lastname: Vanden Eijnden
authors.forename: P
authors.initials: P
authors.lastname: Unger
authors.forename: B
authors.initials: B
authors.lastname: Najem
authors.forename: B
authors.initials: B
authors.lastname: Gulbis
authors.forename: Y
authors.initials: Y
authors.lastname: Maréchal
mesh_terms: D001835:Body Weight; D004374:Ductus Arteriosus, Patent / Q000097:blood* / Q000000981:diagnostic imaging / Q000503:physiopathology; D042241:Early Diagnosis; D004452:Echocardiography; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011237:Predictive Value of Tests; D047928:Premature Birth / Q000097:blood*; D011379:Prognosis; D011446:Prospective Studies; D011498:Protein Precursors; D012372:ROC Curve; D012075:Remission, Spontaneous; D012720:Severity of Illness Index; D013997:Time Factors
chemical_list: D010446:Peptide Fragments; D011498:Protein Precursors; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain