Serial serum brain-type natriuretic peptide (BNP) identifies compromised blood flow in infants with hemodynamically significant patent ductus arteriosus
Vol. 6 No. 2 (2017), Articles
Vol. 6 No. 2 (2017)

Serial serum brain-type natriuretic peptide (BNP) identifies compromised blood flow in infants with hemodynamically significant patent ductus arteriosus

Articles
https://doi.org/10.7363/060213
Published 2017-08-15
Yasser Elsayed
Section of Neonatology, Department of Paediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
Mary Seshia
Section of Neonatology, Department of Paediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
Ronald J. Baier
Section of Neonatology, Department of Paediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
Shyamala Dakshinamurti
Section of Neonatology, Department of Paediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
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Keywords

brain-type natriuretic peptide
PDA
preterm
blood flow
targeted neonatal echo

How to Cite

Elsayed, Y., Seshia, M., Baier, R. J., & Dakshinamurti, S. (2017). Serial serum brain-type natriuretic peptide (BNP) identifies compromised blood flow in infants with hemodynamically significant patent ductus arteriosus. Journal of Pediatric and Neonatal Individualized Medicine (JPNIM), 6(2), e060213. https://doi.org/10.7363/060213
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Abstract

Background: The physiological correlates of elevated serum brain-type natriuretic peptide (BNP) in hemodynamically significant patent ductus arteriosus (HSPDA) are unclear.

Objective: To determine if serial BNP measured at 48-72 hours of age, before and after non-steroidal anti-inflammatory drugs (NSAID) treatment of HSPDA reflect compromised blood flow indices, in infants < 31 weeks of gestational age (GA).

Design/methods: In a prospective blinded study, 70 infants < 31 weeks GA, admitted to Winnipeg NICUs from August 2010 to September 2011, had serum BNPs and echocardiograms at 48-72 hours of age, before and after medical treatment of HSPDA. All BNP and logarithm of BNP (logBNP) were correlated by linear regression with contemporaneous blood flow indices for: 1) systemic hemodynamic indices (corrected left and right ventricular outputs [LVO, RVO], RVO/LVO ratio, superior vena cava flow [SVCF], SVCF/LVO); 2) regional blood flow indices (middle cerebral artery flow [MCAF], MCAF/LVO ratio, middle cerebral artery resistive index [MCARI], middle cerebral artery pulsatility index [MCAPI]; celiac artery flow [CAF], CAF/LVO ratio, celiac artery resistive index [CARI], and celiac artery pulsatility index [CAPI]).

Results: Twenty-six of 70 infants developed HSPDA at 6 ± 2 days. Both BNP and logBNP had similar correlations with all indices, but logBNP showed better goodness of fit. The best correlation was at 48-72 hours of life. Analyzing systemic hemodynamics, logBNP best correlated with SVCF (β -0.49, R2 0.24, p < 0.0001), SVCF/LVO (β -0.55, R2 0.31, p < 0.0001), RVO/LVO (β -0.59, R2 0.35, p < 0.0001), LVO (β 0.4, R2 0.16, p < 0.0001), and RVO (β -0.35, R2 0.12, p < 0.0001). For regional blood flow, logBNP best correlated with MCARI (β 0.6, R2 0.35, p < 0.0001), MCAPI (β 0.5, R2 0.29, p < 0.001), and MCAF (β -0.34, R2 0.12, p < 0.0001).

Conclusions: BNP correlates with blood flow indices in preterm infants with HSPDA mainly at 48-72 hours reflecting the value of pre-symptomatic physiologic prediction by BNP.

https://doi.org/10.7363/060213
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