title: Application of NT-proBNP in ventilator weaning for preterm infants with RDS.
abstract: OBJECTIVE
  To evaluate the value of N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels along with spontaneous breathing trial (SBT) in the prediction of ventilator weaning outcome among respiratory distress syndrome (RDS) preterm infants ready to wean.
  
  
  METHODS
  NT-proBNP along with plasma albumin concentration, serum sodium, serum potassium, and hematocrit were measured immediately before SBT in preterm infants (≤32 weeks) mechanically ventilated due to RDS. Extubation was considered successful if infants remained extubated >48 hr. Either SBT failure or extubation failure was considered weaning failure.
  
  
  RESULTS
  Sixty-three of 88 infants passed the SBT and were subsequently extubated. Of these, two (3.2%) cases rapidly developed laryngeal dyspnea imposing reintubation (excluded from analysis). Of the remaining 61 infants, 45 (73.8%) cases had successful extubation, and 16 (26.2%) cases were reintubated. Infants who failed weaning had lower gestational age, birth weight, and plasma albumin concentrations, higher NT-proBNP, doses of surfactant, occurrence of ventilator-associated pneumonia, and occurrence of pulmonary arterial hypertension than those who did not. NT-proBNP was the only independent factor that could predict weaning failure (OR = 1.872; P = 0.044). The ROC-AUC for NT-proBNP to predict weaning failure was 0.977 (95% CI 0.918-0.997; P < 0.001). The cut-off of NT-proBNP level 18,500 pg/ml to predict weaning failure had a positive likelihood ratio of 25.180. The addition of NT-proBNP to SBT in prediction of weaning failure significantly improved the net reclassification improvement (NRI = 0.224; P = 0.034).
  
  
  CONCLUSIONS
  NT-proBNP is an independent factor that could predict weaning failure. Measurement of NT-proBNP prior to SBT may be helpful in promoting successful ventilator weaning along with SBT.
authors.affiliation: Department of Pediatric, The First Affiliated Hospital of Zhengzhou University, Zhengzhou City, China.
authors.forename: Qian
authors.initials: Q
authors.lastname: Zhang
authors.forename: Zan Yang
authors.initials: ZY
authors.lastname: Shi
authors.forename: Cheng Han
authors.initials: CH
authors.lastname: Luo
authors.forename: Li
authors.initials: L
authors.lastname: Wang
authors.forename: Shan Shan
authors.initials: SS
authors.lastname: Zhang
authors.forename: Xin Ru
authors.initials: XR
authors.lastname: Cheng
authors.forename: Qin
authors.initials: Q
authors.lastname: Zhang
authors.forename: Qian Ya
authors.initials: QY
authors.lastname: Xu
authors.forename: Hong Xiang
authors.initials: HX
authors.lastname: Guo
authors.forename: Xiu Yong
authors.initials: XY
authors.lastname: Cheng
authors.forename: Guang Yao
authors.initials: GY
authors.lastname: Sheng
mesh_terms: D005260:Female; D006400:Hematocrit; D006801:Humans; D006976:Hypertension, Pulmonary / Q000097:blood; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D053717:Pneumonia, Ventilator-Associated / Q000097:blood; D011188:Potassium / Q000097:blood; D011379:Prognosis; D012127:Respiratory Distress Syndrome, Newborn / Q000097:blood* / Q000628:therapy; D012709:Serum Albumin; D012964:Sodium / Q000097:blood; D015300:Ventilator Weaning
chemical_list: D010446:Peptide Fragments; D012709:Serum Albumin; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D012964:Sodium; D011188:Potassium
keywords: N-terminal pro-B-type natriuretic peptide (NT-proBNP); mechanical ventilation (MV); spontaneous breathing trial (SBT); ventilator weaning