September 2008: N-terminal pro-B-type natriuretic peptide: a measure of significant patent ductus arteriosus

[Stefan Johansson]

Leading articles - September 2008

The Leading article for September 2008 is about N-terminal pro-B-type natriuretic peptid (NT-proBNP) as a marker of significant patent ductus arteriosus.

The article is published in collaboration with the journal Archives of Disease in Childhood (http://adc.bmj.com/).

Permission to publish the abstract has been given by Archives of Disease in Childhood and the authors.

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N-terminal pro-B-type natriuretic peptide: a measure of significant patent ductus arteriosus

I Farombi-Oghuvbu, T Matthews, P D Mayne, H Guerin, J D Corcoran
Departments of Neonatal Paediatrics and Clinical Biochemistry, Rotunda Hospital, Dublin, Ireland

ABSTRACT

Background: B-type natriuretic peptide (BNP) is a marker for ventricular dysfunction secreted as a pre-prohormone, pro-B-type natriuretic peptide (proBNP), and cleaved into BNP and a biologically inactive fragment, N-terminal pro-B-type natriuretic peptide (NT-proBNP). Little is known about the clinical usefulness of NT-proBNP in preterm infants.

Objective: To evaluate the usefulness of plasma NT-proBNP in diagnosing haemodynamically significant patent ductus arteriosus (hsPDA) in neonates and examine some factors that might affect this.

Methods: Infants born at <34 weeks’ gestational age (GA) and <2 kg birth weight (BW) were prospectively enrolled within 6–12 hours of birth. Plasma NT-proBNP levels were measured on days 1, 3, 5 and 10 with simultaneous echocardiography done to detect hsPDA and assess ventricular function. Significant PDA was diagnosed by large ductal flow with left to right shunt on colour Doppler, measuring >1.6 mm on two-dimensional echocardiography, along with clinical features of PDA.

Results: Forty-nine infants were analysed. Median GA was 30 weeks (range 24–33) and median BW 1220 g (range 550–1950). Eighteen infants with hsPDA had higher day 3 plasma NT-proBNP values (median 32 907 pg/ml; range 11 396–127 155) (p<0.001) than controls (median 3147 pg/ml; range 521–10 343). Infants who developed sepsis had higher day 10 plasma NT-proBNP levels. Area under receiver operator characteristic curve for detection of hsPDA, by day 3 NT-proBNP value, was significant 0.978 (95% CI 0.930 to 1.026). NT-proBNP was predictive of hsPDA (sensitivity 100%; specificity 95%) at a cut-off value of 11 395 pg/ml.

Conclusion: Plasma NT-proBNP level on day 3 is a good marker for hsPDA in preterm infants. Serial measurements of NT-proBNP may be useful in assessing the clinical course of PDA.


Click here to read the article in full text! (http://fn.bmj.com/cgi/content/full/93/4/F257)

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You may comment the article directly below or discuss diagnosis and treatment of PDA in appropriate forums.

[ammar]

Good night (it's 2: 23 mn am at the children's hospital of Tunis)

I think it's very good idea to identify a real screening test to define Hemd. significant PCA. but i think also that the first condition required is to search something that is usual, common and reliable. also that should be sufficient in regard to cost.
NT-proBNP was predictive of hsPDA (sensitivity 100%; specificity 95%) but when and where i can find it in a development country like TUNISIA (I think also that the situation in IRELAND is not very different for using it commonly).
thank you.

[Stefan Johansson]

ammar, I guess you put your finger on something important in the world of neonatology, that some resources are not available everywhere. Maybe you could email the authors and ask how the analyses are done, at what cost etc. If you get a response, please share it with us here.

Regarding diagnosis of PDA. I think there is only one way to make a truly reliable diagnosis... echocardiography. VERY significant shunting is common during the first day of life in extremely preterm infants, and there is no clinical indicators that tell about this until days later. With echocardiography you will literally see what's going on!

[Darya]

Very interesting article. And I absolutely agree with Stefan - echocardiography and clinic. But may be NT-proBNP level could be an additional objective criterion.