title: Circulating N-terminal pro-B-type natriuretic peptide in fetal anemia before and after treatment.
abstract: BACKGROUND
  N-terminal pro-B-type natriuretic peptide (ntproBNP) is an established marker of heart failure in adult cardiology. We analyzed nt-proBNP in the circulation of fetuses with increased volume load secondary to anemia and investigated the effect of treatment on nt-proBNP concentration.
  
  
  METHODS
  Fetuses undergoing intrauterine transfusion (IUT) were examined. nt-proBNP was measured before IUT and correlated with hemoglobin concentrations, ultrasonographic findings, and Doppler measurements of the peak systolic velocity of the middle cerebral artery (MCA-PSV).
  
  
  RESULTS
  A total of 27 patients (7 with hydrops) and 78 controls were examined. nt-proBNP was markedly elevated in anemia (P < 0.001). Concentrations were highest in hydropic fetuses (P < 0.03); no differences were present in hemoglobin and MCA-PSV values between hydropic and nonhydropic cases. In fetuses undergoing multiple IUTs nt-proBNP normalized after the third IUT, whereas hemoglobin and MCA-PSV remained abnormal.
  
  
  CONCLUSIONS
  Levels of circulating nt-proBNP correlate well with the degree of myocardial workload in the hyperdynamic state of fetal anemia. We hypothesize that normalization of nt-proBNP after serial transfusions is an indicator of myocardial adjustment to chronic anemia. nt-proBNP measurement may be useful in the management of fetal anemia, particularly in cases at risk of hydrops and fetuses requiring multiple transfusions.
authors.affiliation: Department of Obstetrics and Prenatal Medicine, University of Bonn Medical School, Germany. waltraut.merz@ukb.uni-bonn.de
authors.forename: Waltraut M
authors.initials: WM
authors.lastname: Merz
authors.forename: Kirsten
authors.initials: K
authors.lastname: Kübler
authors.forename: Rolf
authors.initials: R
authors.lastname: Fimmers
authors.forename: Birgit
authors.initials: B
authors.lastname: Stoffel-Wagner
authors.forename: Annegret
authors.initials: A
authors.lastname: Geipel
authors.forename: Ulrich
authors.initials: U
authors.lastname: Gembruch
mesh_terms: D000740:Anemia / Q000097:blood* / Q000503:physiopathology / Q000628:therapy; D015415:Biomarkers / Q000097:blood; D001783:Blood Flow Velocity; D001805:Blood Transfusion, Intrauterine / Q000379:methods*; D016022:Case-Control Studies; D004452:Echocardiography; D005315:Fetal Diseases / Q000097:blood* / Q000503:physiopathology / Q000628:therapy; D006333:Heart Failure / Q000097:blood / Q000175:diagnosis*; D006801:Humans; D015160:Hydrops Fetalis / Q000503:physiopathology*; D017078:Laser-Doppler Flowmetry; D020768:Middle Cerebral Artery / Q000502:physiology; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D018709:Statistics, Nonparametric
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain