Urinary NT-proBNP, NGAL, and H-FABP may predict hemodynamic relevance of patent ductus arteriosus in very low birth weight infants.
BACKGROUND
Hemodynamically significant patent ductus arteriosus (hsPDA) is the most common functional cardiovascular disease in preterm infants. The necessity to treat hsPDA can neither be derived solely from clinical nor from echocardiographic criteria.


OBJECTIVE
The aim of this study was to establish non-invasive parameters which can differentiate hsPDA from non-hsPDA.


METHODS
Urinary protein levels of NT-proBNP, NGAL, and H-FABP were measured and correlated with the necessity of therapy for PDA. In 37 neonates (<1,500 g), urinary protein concentrations were tested on days 0, 2, and 7 by ELISA methodology. Of 37 infants, 12 required therapeutic interventions according to current treatment standards.


RESULTS
Infants receiving an intervention for PDA showed significantly higher levels of pro-BNP, NGAL, and H-FABP at all time points except for NT-proBNP on day 0. Infants requiring a second or third course of ibuprofen had significantly higher levels of H-FABP and NGAL. In all samples, the concentration of the three proteins correlated positively with each other.


CONCLUSIONS
The present study shows that measurement of urinary proteins is a powerful and non-invasive method to quantify the effect of PDA on systemic perfusion in preterm infants. Furthermore, NGAL and H-FABP may be used to indicate the necessity of pharmacological or surgical treatment of PDA.
Neonatology and Pediatric Intensive Care Medicine, Department of General Pediatrics, Heinrich Heine University, Düsseldorf, Germany.
Veronika
V
Tosse
Frank
F
Pillekamp
Pablo
P
Verde
Berit
B
Hadzik
Hemmen
H
Sabir
Ertan
E
Mayatepek
Thomas
T
Hoehn
D000209:Acute-Phase Proteins / Q000032:analysis / Q000652:urine*; D001724:Birth Weight / Q000502:physiology; D016022:Case-Control Studies; D004374:Ductus Arteriosus, Patent / Q000175:diagnosis* / Q000503:physiopathology / Q000652:urine; D000074026:Fatty Acid Binding Protein 3; D050556:Fatty Acid-Binding Proteins / Q000032:analysis / Q000652:urine*; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature / Q000652:urine; D007235:Infant, Premature, Diseases / Q000175:diagnosis / Q000503:physiopathology / Q000652:urine; D019102:Infant, Very Low Birth Weight / Q000502:physiology / Q000652:urine*; D000071068:Lipocalin-2; D054834:Lipocalins / Q000032:analysis / Q000652:urine*; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000032:analysis / Q000652:urine*; D010446:Peptide Fragments / Q000032:analysis / Q000652:urine*; D011379:Prognosis; D011518:Proto-Oncogene Proteins / Q000032:analysis / Q000652:urine*
D000209:Acute-Phase Proteins; C493408:FABP3 protein, human; D000074026:Fatty Acid Binding Protein 3; D050556:Fatty Acid-Binding Proteins; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D054834:Lipocalins; D010446:Peptide Fragments; D011518:Proto-Oncogene Proteins; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain