title: [Usefulness of brain natriuretic propeptide in the diagnosis and management of patent ductus arteriosus].
abstract: BACKGROUND
  Patent ductus arteriosus (PDA) is a prevalent condition in preterm infants, and may be related to increased morbidity and mortality in the most immature newborns. Recent studies have examined the usefulness of brain natriuretic propeptide (proBNP) in the diagnosis of this pathology. The aim of the study was to evaluate the diagnostic efficacy of proBNP as a marker of hemodynamic overload in PDA.
  
  
  METHODS
  A retrospective study was conducted on preterm infants less than 32 weeks of gestation and/or weight less than 1500 grams. Echocardiogram and determination of proBNP levels were performed on all patients. Comparison was made by subgroups according to the presence of PDA and their haemodynamic characteristics.
  
  
  RESULTS
  Of the 60 patients enrolled, 71.7% had PDA, of which 86% had haemodynamically significant patent ductus arteriosus (HS-PDA). All of them, but one, received medical treatment with ibuprofen or acetaminophen. Surgical closure was required in 29.7% of HS-PDA. Higher values of proBNP were found in patients with HS-PDA (33338±34494.47pg/mL; p=.000) compared with patients with closed or non-haemodynamically significant ductus arteriosus. Higher values were also found in patients who required surgical closure of PDA (30596.8±14910.9; p=.004). A greater decrease inproBNP levels was found in the group of patients which duct closure after pharmacological treatment (68±24.69% vs -12.22±99.4%; p=.030). ProBNP cutoff-level for HS-PDA was calculated by ROC curve and it was 9321.5pg/mL (Specificity: 100%, Sensitivity: 94.6%).
  
  
  CONCLUSIONS
  ProBNP levels are related to the presence or absence of haemodynamically significant patent ductus arteriosus; and its variations with treatment response. High values are also related to the need for surgical closure of PDA.
authors.affiliation: Unidad de Neonatología, Servicio de Pediatría, Hospital Infantil Miguel Servet, Zaragoza, España. Electronic address: alicia87mr@hotmail.com.
authors.forename: Alicia
authors.initials: A
authors.lastname: Montaner Ramón
authors.affiliation: Unidad de Neonatología, Servicio de Pediatría, Hospital Infantil Miguel Servet, Zaragoza, España.
authors.forename: Zenaida
authors.initials: Z
authors.lastname: Galve Pradel
authors.affiliation: Unidad de Neonatología, Servicio de Pediatría, Hospital Infantil Miguel Servet, Zaragoza, España.
authors.forename: Cristina
authors.initials: C
authors.lastname: Fernández Espuelas
authors.affiliation: Unidad de Cardiología pediátrica, Servicio de Pediatría, Hospital Infantil Miguel Servet, Zaragoza, España.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Jiménez Montañés
authors.affiliation: Servicio de Pediatría, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España.
authors.forename: María Pilar
authors.initials: MP
authors.lastname: Samper Villagrasa
authors.affiliation: Unidad de Neonatología, Servicio de Pediatría, Hospital Infantil Miguel Servet, Zaragoza, España.
authors.forename: Segundo
authors.initials: S
authors.lastname: Rite Gracia
mesh_terms: D004374:Ductus Arteriosus, Patent / Q000097:blood / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011498:Protein Precursors / Q000097:blood*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
chemical_list: D011498:Protein Precursors; C063382:prepro-brain natriuretic peptide; D020097:Natriuretic Peptide, Brain
keywords: Brain natriuretic propeptide; Ductus arterioso persistente; Especificidad; Patent arteriosus ductus; Prematuridad; Prematurity; Propéptido natriurético cerebral; Sensibilidad; Sensitivity; Specificity