NT-proBNP levels improve the ability of predicting a hemodynamically significant patent ductus arteriosus in very low-birth-weight infants

Abstract

PURPOSE: A hemodynamically significant Patent ductus arteriosus (HsPDA) in premature infants is known to be associated with significant morbidity. Recently brain natriuretic peptides and superior mesenteric artery (SMA)-resistive indices have been used to effectively diagnose HsPDA. OBJECTIVE: To assess the sensitivity and specificity of N-terminal proBNP (NT-proBNP) in predicting an HsPDA diagnosed by clinical and echocardiographic criteria including pulsatility index (PI) of SMA. MATERIALS AND METHODS: All preterm neonates <1500 g were evaluated with echocardiograms and NT-proBNP levels on the 3(rd) to 5(th) day of life and then every week until the echo showed either a closed PDA or non-HsPDA. RESULTS: Sixty-nine babies with mean gestational age of 27 weeks were included in the study. NT-proBNP levels were significantly higher in the HsPDA group (n=22) with a mean±SEM of 24420±3190 compared to 3072±332 in the non-HsPDA group (n=47) (P<0.001). NT-pro BNP level of 5900 pg/ml had 96% sensitivity and 90% specificity of predicting HsPDA. CONCLUSIONS: With frequently changing hemodynamics in low-birth weight infants, including NT-proBNP and PI of SMA improve the ability of assessing the effects of a HsPDA and will help timing of intervention.