title: Plasma C-terminal pro-endothelin-1 and the natriuretic pro-peptides NT-proBNP and MR-proANP in very preterm infants with patent ductus arteriosus.
abstract: BACKGROUND
  In very preterm infants, clinical decision-making, such as closing a patent ductus arteriosus (PDA), may be aided by measuring circulating natriuretic and endothelial pro-peptides.
  
  
  OBJECTIVE
  To investigate the association between perinatal characteristics, PDA echocardiography and plasma concentrations of stable pro-peptides of B-type natriuretic peptide (NT-proBNP), atrial natriuretic peptide (MR-proANP) and endothelin-1 (CT-proET-1).
  
  
  METHODS
  A prospective, cross-sectional, single-center study was performed in 66 infants who were less than 32 weeks of gestational age. Pro-peptide concentrations were determined at birth and at day 2-3 of life.
  
  
  RESULTS
  Plasma concentrations of all 3 pro-peptides increased on average 2- to 5-fold from birth to day 2-3 of life. NT-proBNP and MR-proANP were closely related at birth and at day 2-3 (Rs 0.902 and 0.897, respectively, p < 0.001), whereas CT-proET-1 was related to NT-proBNP and MR-proANP at birth (Rs 0.478 and 0.460, respectively, p < 0.001) but not at day 2-3. Birth weight was negatively related to all 3 pro-peptides at birth (p < 0.01); however, preeclampsia and compromised placental perfusion were associated with elevated NT-proBNP and MR-proANP concentrations at birth. At day 2-3, MR-proANP and NT-proBNP correlated significantly with the ductal diameter (Rs 0.416 and 0.415, respectively, both p = 0.011), whereas CT-proET-1 correlated with the left atrium/aorta ratio (Rs 0.506, p = 0.027). CT-proET-1 was elevated in infants with treated compared to untreated PDA [median (5-95% range) 388 (272-723) vs. 303 (152-422) pmol/l, p = 0.011], but not NT-proBNP or MR-proANP.
  
  
  CONCLUSIONS
  CT-proET-1 is a promising predictor in determining the need for PDA intervention.
authors.affiliation: Division of Neonatology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Julia
authors.initials: J
authors.lastname: Letzner
authors.forename: Florian
authors.initials: F
authors.lastname: Berger
authors.forename: Sarah
authors.initials: S
authors.lastname: Schwabe
authors.forename: Jörg
authors.initials: J
authors.lastname: Benzing
authors.forename: Nils G
authors.initials: NG
authors.lastname: Morgenthaler
authors.forename: Hans Ulrich
authors.initials: HU
authors.lastname: Bucher
authors.forename: Christoph
authors.initials: C
authors.lastname: Bührer
authors.forename: Romaine
authors.initials: R
authors.lastname: Arlettaz
authors.forename: Sven
authors.initials: S
authors.lastname: Wellmann
mesh_terms: D009320:Atrial Natriuretic Factor / Q000097:blood*; D004374:Ductus Arteriosus, Patent / Q000097:blood* / Q000000981:diagnostic imaging; D004452:Echocardiography; D019332:Endothelin-1 / Q000097:blood*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature / Q000097:blood*; D007235:Infant, Premature, Diseases / Q000097:blood; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D010920:Placenta / Q000098:blood supply; D011225:Pre-Eclampsia / Q000097:blood; D011247:Pregnancy; D011498:Protein Precursors / Q000097:blood*
chemical_list: D019332:Endothelin-1; D010446:Peptide Fragments; D011498:Protein Precursors; C109794:pro-brain natriuretic peptide (1-76); C093240:proendothelin 1; D020097:Natriuretic Peptide, Brain; D009320:Atrial Natriuretic Factor