Abstract
Background/aims: In preterm infants, the rapid and accurate determination of the presence of a hemodynamically significant patent ductus arteriosus (hsPDA) is extremely important, but this is often difficult. Plasma B-type natriuretic peptide (BNP) measurement has been reported to be a helpful aid in the diagnosis of hsPDA in preterm infants. The aim of our study was to investigate the usefulness of rapid BNP assay as a diagnostic marker of symptomatic PDA (sPDA) in preterm infants.
Methods: 66 preterm infants, ranging from 25 to 34 gestational weeks of age, underwent clinical and echocardiographic examinations for PDA every other day from the third day of life until the disappearance of ductal flow. Simultaneously, plasma BNP concentrations were measured using a commercial kit, TriageĀ® BNP test kit (Biosite Diagnositics, San Diego, California, U.S.A.). When two or more clinical significant features of PDA were noted, and a large ductal flow was confirmed by color Doppler echocardiography, sPDA was diagnosed and treated with indomethacin.
Results: On the third day of birth, the BNP concentration in the sPDA group (N=23) was significantly higher than in the control group (N=43) (P <0.001). 17 infants (74%) in the sPDA group became asymptomatic after a first course of indomethacin and their BNP levels concomitantly decreased. In the control group, only 14 infants (32.5%) had a ductal shunt but did not develop sPDA (asPDA infants). The BNP concentration of asPDA infants was significantly higher than that of closed PDA infants (P <0.001). Moreover, BNP concentrations were significantly correlated with the magnitudes of the ductal shunt, such as the ratio of left atrial to aortic root diameter and the diastolic flow velocity of the left pulmonary artery (r = 0.686 and r = 0.839, respectively, P <0.001). The area under the ROC curve using BNP to diagnose sPDA was 0.997 (95% CI, 0.991 to 1.004, P < 0.001). A cutoff BNP value of 1,110 pg/mL had a sensitivity of 92.0%, specificity of 100% and a positive predictive value of 100% for diagnosis of sPDA.
Conclusion: Although not a stand-alone test, the rapid BNP assay clearly adds valuable information for the detection of preterm infants with sPDA that require treatment. Particularly, a cutoff BNP level of 1,110 pg/mL differentiated well between preterm infants with and without sPDA. Moreover, serial plasma BNP measurements may be of value in determining the clinical course of PDA in preterm infants.
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Choi, B., Lee, K., Eun, B. et al. 50 Utility of Rapid B-Type Natriuretic Peptide Assay for Diagnosis of Symptomatic Patent Ductus Arteriosus in Preterm Infants. Pediatr Res 56, 472 (2004). https://doi.org/10.1203/00006450-200409000-00073
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DOI: https://doi.org/10.1203/00006450-200409000-00073