Predictive value of serum NT-proBNP concentrations for assessment hemodynamically significant patent ductus arteriosus in very preterm infants

Hemodynamically significant patent ductus arteriosus (PDA) is a common complication in very preterm infants born at less than 32 weeks of gestation. At the same time, currently, there are no uniform criteria to identify the actual hemodynamic significance of PDA and generally accepted management approaches to such infants. Purpose — to assess the predictive value of serum N-terminal pro-brain natriuretic peptide (NT-proBNP) levels for hemodynamically significant PDA in very preterm infants. Materials and methods. Fifty-two preterm infants with gestational age <32 weeks, chronological age <72 h, and PDA diameter >1.5 mm were involved in a randomized study. Twenty-seven (52%) of them were treated with ibuprofen or paracetamol starting within the first 3 days of life. Expectant management was applied to 25 (48%) infants. All patients underwent daily echocardiographic and two serum NT-proBNP measurements within the first 10 days after birth. According to the results of echocardiographic and clinical monitoring, 2 groups of patients were formed retrospectively. In 22 (42%) of them hemodynamically significant PDA (hsPDA) was diagnosed, and 30 (58%) had hemodynamically insignificant ductus arteriosus. Results. The percentage of infants who received pharmacological PDA treatment was not significantly different between the groups (p>0.05). Serum NT-proBNP concentrations at the median age of 2 and 8 days were significantly higher in infants with hsPDA (p<0.01). By the eighth day of life, the NT-proBNP level in both groups significantly decreased but remained considerably higher in newborns with hsPDA. Serum NT-proBNP concentrations on the second-third day of life could reliably predict hsPDA (AUC=0.93; 95% confidence interval: 0.86–1.0; p<0.05). Conclusions. Serum NT-proBNP concentrations on the second day of life >12000 pg/ml could reliably predict hsPDA. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of these Institutes. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: hemodynamically significant patent ductus arteriosus, PDA, NT-proBNP, prognostic value, very preterm infants.

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Patent ductus arteriosus, systemic NT-proBNP concentrations and development of bronchopulmonary dysplasia in very preterm infants: retrospective data analysis from a randomized controlled trial

BMC Pediatrics ◽

10.1186/s12887-021-02750-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Solomiia Potsiurko ◽

Dmytro Dobryanskyy ◽

Lesya Sekretar

Keyword(s):

Randomized Controlled Trial ◽

Patent Ductus Arteriosus ◽

Preterm Infants ◽

Roc Curve ◽

Controlled Trial ◽

Ductus Arteriosus ◽

Very Preterm Infants ◽

Very Preterm ◽

Randomized Controlled ◽

Patent Ductus

Abstract Background Patent ductus arteriosus (PDA) is a common complication in very preterm infants. It is known that there is an association between PDA and development of bronchopulmonary dysplasia (BPD) or death before the postmenstrual age (PMA) of 36 weeks, but this association remains one of the most controversial aspects of the problem. The study aimed to evaluate the relationship between PDA, serum NT-proBNP levels at 2–3 and 8–9 days of life, and BPD/death in very preterm infants. Methods Data of 52 preterm infants with a gestational age < 32 weeks, chronological age < 72 h, and PDA diameter > 1.5 mm, enrolled in a randomized controlled trial, were used for the retrospective analysis. All patients underwent daily echocardiographic and two serum NT-proBNP measurements within the first 10 days after birth. Two groups of infants were formed retrospectively at PMA of 36 weeks depending on the outcome, BPD (n = 18)/death (n = 7) or survival without BPD (n = 27). Receiver operator characteristic (ROC) curve was used to evaluate the predictive performance of serum NT-proBNP levels for BPD/death occurrence. Results The percentage of infants who received pharmacological treatment for PDA did not differ between the groups. Based on the area under the ROC curve, serum NT-proBNP levels on the 2–3 day of life (AUC = 0.71; 95% confidence interval (CI): 0.56–0.9; p = 0.014)) and on the 8–9 day of life (AUC = 0.76; 95% CI: 0.6–0.9; p = 0.002) could reliably predict BPD/death in very preterm infants who had PDA diameter > 1.5 mm in the first 72 h of life. Hemodynamically significant PDA (hsPDA) was significantly more often detected in newborns with BPD/death, however, treatment of infants with hsPDA did not reduce the incidence of BPD/death. Conclusions In very preterm infants with PDA > 1.5 mm at the age of 24–48 h, serum NT-proBNP concentration could reliably predict the development of BPD or death, regardless of the persistence of PDA, with the highest diagnostic value at 8–9 days. Trial registration This study is registered in ClinicalTrials.gov - NCT03860428 on March 4, 2019.

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Anterior mini-thoracotomy versus transcatheter closure of patent ductus arteriosus in very preterm infants

Archives of Cardiovascular Diseases Supplements ◽

10.1016/j.acvdsp.2021.06.023 ◽

2021 ◽

Vol 13 (4) ◽

pp. 282-283

Author(s):

Chloé Wanert ◽

Marien Lenoir ◽

Damien Bonnet ◽

Mathilde Meot ◽

Virginie Fouilloux ◽

...

Keyword(s):

Patent Ductus Arteriosus ◽

Preterm Infants ◽

Transcatheter Closure ◽

Ductus Arteriosus ◽

Very Preterm Infants ◽

Very Preterm ◽

Mini Thoracotomy ◽

Patent Ductus

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Lung function in very preterm infants with patent ductus arteriosus under conservative management: an observational study

BMC Pediatrics ◽

10.1186/s12887-015-0480-y ◽

2015 ◽

Vol 15 (1) ◽

Cited By ~ 9

Author(s):

Hsiu-Lin Chen ◽

Rei-Cheng Yang ◽

Wei-Te Lee ◽

Pei-Lun Lee ◽

Jong-Hau Hsu ◽

...

Keyword(s):

Lung Function ◽

Observational Study ◽

Patent Ductus Arteriosus ◽

Preterm Infants ◽

Conservative Management ◽

Ductus Arteriosus ◽

Very Preterm Infants ◽

Very Preterm ◽

Patent Ductus

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Abdominal pathology requiring laparotomy in very preterm infants is associated with need for surgical closure of patent ductus arteriosus

Journal of Pediatric Surgery ◽

10.1016/j.jpedsurg.2011.06.028 ◽

2011 ◽

Vol 46 (10) ◽

pp. 1898-1902 ◽

Cited By ~ 1

Author(s):

Sara Röjås ◽

Helena Borg ◽

Mats Edenholm ◽

Kenneth Sandberg ◽

Anders Elfvin

Keyword(s):

Patent Ductus Arteriosus ◽

Preterm Infants ◽

Ductus Arteriosus ◽

Very Preterm Infants ◽

Surgical Closure ◽

Very Preterm ◽

Patent Ductus

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Effect of Patent Ductus Arteriosus on Splanchnic Oxygenation at Enteral Feeding Introduction in Very Preterm Infants

Journal of Pediatric Gastroenterology and Nutrition ◽

10.1097/mpg.0000000000002420 ◽

2019 ◽

Vol 69 (4) ◽

pp. 493-497 ◽

Cited By ~ 1

Author(s):

Silvia Martini ◽

Luigi Corvaglia ◽

Arianna Aceti ◽

Francesca Vitali ◽

Giacomo Faldella ◽

...

Keyword(s):

Patent Ductus Arteriosus ◽

Preterm Infants ◽

Enteral Feeding ◽

Ductus Arteriosus ◽

Very Preterm Infants ◽

Very Preterm ◽

Splanchnic Oxygenation ◽

Patent Ductus

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Ibuprofen treatment for patent ductus arteriosus in preterm infants: a retrospective cohort study in a leading Chinese center

Frigid Zone Medicine ◽

10.2478/fzm-2021-0013 ◽

2021 ◽

Vol 1 (2) ◽

pp. 103-110

Author(s):

Jia Chen ◽

Jinghua Luo ◽

Hao Liu ◽

Xue Du ◽

Shan Zhang ◽

...

Keyword(s):

Cohort Study ◽

Treatment Group ◽

Patent Ductus Arteriosus ◽

Preterm Infants ◽

Intraventricular Hemorrhage ◽

Retrospective Cohort ◽

Ductus Arteriosus ◽

Very Preterm Infants ◽

Very Preterm ◽

Patent Ductus

Abstract Objective There is a dilemma of ibuprofen treatment with patent ductus arteriosus (PDA) as to how and when to treat. We aimed to clarify this issue in very preterm infants (VPIs; < 32 weeks). Methods This retrospective study included 1 659 VPIs who were diagnosed with PDA according to echocardiographic examinations and cardiovascular dysfunction scoring system (the CVD scoring). The VPIs were classified into six groups (A1, A2, A3, B1, B2, and B3) based on CVD scores (A, < 3, and B, ≥ 3), and treatment with ibuprofen for PDA (1, conservational management; 2, early ibuprofen treatment; and 3, late ibuprofen treatment). Treatment was stopped when PDA was closed, CVD score was zero or PDA needed ligation. Results VPIs with CVD scores < 3 had most PDA closure without surgery, and early ibuprofen treatment did not significantly affect PDA closure. VPIs with CVD scores ≥ 3 had some PDA closure after 2 courses of treatment, but closure rates decreased linearly with ibuprofen course (1st 75.2%, 2nd 62.3%, 3rd 50.0%, P < 0.0001), and early ibuprofen treatment (group B2) did not increase PDA closure compared to late ibuprofen treatment (group B3). In these same infants, the longer they were in CVD scores ≥ 3, the more the complications of preterm were increased (retinopathy of prematurity ROP 1st 16.5%, 2nd 23.8%, 3rd 29.6%, P = 0.016; bronchopulmonary dysplasia BPD 1st 15.5%, 2nd 26.7%, 3rd 33.8%, P < 0.0001; intraventricular hemorrhage IVH 1st 20.4%, 2nd 32.4%, 3rd 23.8%, P = 0.015). Conclusion Ibuprofen is suggested for PDA closure when the PDA reopens or has developed into the stage when the CVD score ≥ 3.

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