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Early N‐terminal pro‐brain natriuretic peptide measurements predict clinically significant ductus arteriosus in preterm infants
Author(s) -
Ramakrishnan S,
Heung YM,
Round J,
Morris TP,
Collinson P,
Williams AF
Publication year - 2009
Publication title -
acta pædiatrica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.772
H-Index - 115
eISSN - 1651-2227
pISSN - 0803-5253
DOI - 10.1111/j.1651-2227.2009.01315.x
Subject(s) - medicine , ductus arteriosus , natriuretic peptide , prospective cohort study , gestation , cardiology , brain natriuretic peptide , receiver operating characteristic , n terminal pro brain natriuretic peptide , gestational age , heart failure , pregnancy , biology , genetics
We report a blinded, prospective study of the diagnostic utility of N‐terminal pro‐brain natriuretic peptide (NTproBNP) measurements for predicting clinically significant patent ductus arteriosus (PDA) and assessing closure. Methods: Plasma NTproBNP was measured during the first week in 100 preterm babies (mean gestation 28.8 ± 2.9 weeks; mean birth weight 1224 ± 512 g). Echocardiography was performed between days 5 and 7 by operators, blinded to NTproBNP concentration. Results: NTproBNP peaked on days 2 and 3, declined by day 7. Twenty babies, later treated for PDA, had significantly higher NTproBNP levels throughout. Areas under receiver operating characteristic (ROC) curves were 0.896, 0.897 and 0.931 on days 2, 3 and 7, respectively (p < 0.0001). A concentration > 2850 pmol/L had diagnostic sensitivity of 90% and specificity of 89% (95% CI: 68, 99; likelihood ratio 8.10). Ductal closure was associated with a fall in mean NTproBNP from 3003 to 839 pmol/L (p < 0.001). Conclusion: N‐terminal pro B‐type brain natriuretic peptide (NTproBNP) concentrations peaked and then declined in the first week but remained higher in preterm babies whose PDA required treatment. NTproBNP on day 3 predicted whether a neonatal physician blinded to results would treat a PDA. Fall in plasma NTproBNP indicated closure.