Steurer Martina A, Moon-Grady Anita J, Fineman Jeff R, Sun Christine E, Lusk Leslie A, Wai Katherine C, Keller Roberta L
Department of Pediatrics, University of California, San Francisco, San Francisco, California.
1] Department of Pediatrics, University of California, San Francisco, San Francisco, California [2] Cardiovascular Research Institute, University of California, San Francisco, San Francisco, California.
Pediatr Res. 2014 Dec;76(6):549-54. doi: 10.1038/pr.2014.136. Epub 2014 Sep 4.
B-type natriuretic peptide (BNP) has not been evaluated in newborns with congenital diaphragmatic hernia (CDH). We hypothesized that BNP and severity of pulmonary hypertension (PH) would predict clinical outcome in these infants.
We measured BNP levels and assessed severity of PH by echocardiography at 1 d and 1 wk of life. Outcome was classified by status at 56 d (or prior discharge): Good (n = 13) if alive on room air and Poor (n = 14) if expired or receiving respiratory support. We estimated area under the curve (AUC) and 95% confidence interval (CI).
BNP levels were higher at 1 d in newborns with Poor outcome (median 220 pg/ml vs. 55 pg/ml, P < 0.01). At 1 wk, there was no significant difference in BNP level (median 547 pg/ml vs. 364 pg/ml, P = 0.70, for Poor and Good outcomes). At 1 d, BNP level predicted outcome (AUC = 0.91, 95% CI = 0.77-1.0), but this relationship dissipated by 1 wk (AUC = 0.55, 95% CI = 0.31-0.79). Severity of PH did not predict outcome at 1 d (AUC = 0.51, 95% CI = 0.27-0.74), but prediction improved at 1 wk (AUC = 0.80, 95% CI = 0.61-0.99).
BNP is a strong predictor of clinical outcome in newborns with CDH at 1 d of life.
B型利钠肽（BNP）尚未在先天性膈疝（CDH）新生儿中进行评估。我们假设BNP和肺动脉高压（PH）的严重程度可预测这些婴儿的临床结局。
我们在出生1天和1周时测量BNP水平，并通过超声心动图评估PH的严重程度。结局根据56天（或提前出院）时的状况分类：若在室内空气中存活则为良好（n = 13），若死亡或接受呼吸支持则为不良（n = 14）。我们估计曲线下面积（AUC）和95%置信区间（CI）。
结局不良的新生儿在出生1天时BNP水平较高（中位数220 pg/ml对55 pg/ml，P < 0.01）。在出生1周时，BNP水平无显著差异（不良和良好结局的中位数分别为547 pg/ml和364 pg/ml，P = 0.70）。在出生1天时，BNP水平可预测结局（AUC = 0.91，95%CI = 0.77 - 1.0），但这种关系在出生1周时消失（AUC = 0.55，95%CI = 0.31 - 0.79）。PH的严重程度在出生1天时不能预测结局（AUC = 0.51，95%CI = 0.27 - 0.74），但在出生1周时预测能力有所改善（AUC = 0.80，95%CI = 0.61 - 0.99）。
BNP是出生1天时CDH新生儿临床结局的有力预测指标。
