title: N-Terminal Pro-B Type Natriuretic Peptide as a Marker of Bronchopulmonary Dysplasia or Death in Very Preterm Neonates: A Cohort Study.
abstract: BACKGROUND
  Bronchopulmonary dysplasia (BPD) is a serious complication of preterm birth. Plasma N-terminal pro-B type natriuretic peptide (NT-proBNP) has been suggested as a marker that may predict BPD within a few days after birth.
  
  
  OBJECTIVE
  To investigate the association between NT-proBNP day three and bronchopulmonary dysplasia (BPD) or death and further to assess the impact of patent ductus arteriosus (PDA) on this association in neonates born before 32 gestational weeks.
  
  
  METHODS
  A cohort study of 183 neonates born before 32 gestational weeks consecutively admitted to the Neonatal Intensive Care Unit, Aarhus University Hospital, Denmark. On day three plasma samples were collected and echocardiography carried out. NT-proBNP was measured by routine immunoassays. The combined outcome BPD or death was assessed at 36 weeks of postmenstrual age. Receiver operator characteristic (ROC) analysis was performed to determine the discrimination ability of NT-proBNP by the natural log continuous measure to recognize BPD or death. The association of BPD or death was assessed in relation to natural log NT-proBNP levels day three.
  
  
  RESULTS
  The risk of BPD or death increased 1.7-fold with one unit increase of natural log NT-proBNP day three when adjusted for gestational age at birth (OR = 1.7, 95% CI 1.3; 2.3). The association was found both in neonates with and without a PDA. Adjusting for GA, PDA diameter, LA:Ao-ratio, or early onset sepsis did not change the estimate.
  
  
  CONCLUSIONS
  We found NT-proBNP to be associated with BPD or death in very preterm neonates. This association was not only explained by the PDA. We speculate that NT-proBNP may help the identification of neonates at risk of BPD as early as postnatal day three.
authors.affiliation: Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark; Perinatal Epidemiology Research Unit, Aarhus University, Aarhus, Denmark; Department of Pediatrics, Herning Regional Hospital, Herning, Denmark.
authors.forename: Anna
authors.initials: A
authors.lastname: Sellmer
authors.affiliation: Department of Cardiothoracic surgery, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Vibeke Elisabeth
authors.initials: VE
authors.lastname: Hjortdal
authors.affiliation: Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Jesper Vandborg
authors.initials: JV
authors.lastname: Bjerre
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Michael Rahbek
authors.initials: MR
authors.lastname: Schmidt
authors.affiliation: Division of Neonatology, Hospital for Sick Children, Toronto, Canada.
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: McNamara
authors.affiliation: Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus, Denmark.
authors.forename: Bodil Hammer
authors.initials: BH
authors.lastname: Bech
authors.affiliation: Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark; Perinatal Epidemiology Research Unit, Aarhus University, Aarhus, Denmark.
authors.forename: Tine Brink
authors.initials: TB
authors.lastname: Henriksen
mesh_terms: D015415:Biomarkers / Q000097:blood; D001997:Bronchopulmonary Dysplasia / Q000097:blood* / Q000150:complications / Q000000981:diagnostic imaging; D015331:Cohort Studies; D003718:Denmark; D004374:Ductus Arteriosus, Patent / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D007223:Infant; D062071:Infant, Extremely Premature / Q000097:blood*; D007231:Infant, Newborn; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D047928:Premature Birth / Q000097:blood*; D012307:Risk Factors; D014463:Ultrasonography
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain