University of Otago, Christchurch, New Zealand.
Neonatal Unit, Christchurch Women's Hospital, Christchurch, New Zealand.
Eur J Pediatr. 2018 Apr;177(4):521-532. doi: 10.1007/s00431-018-3089-y. Epub 2018 Jan 19.
This study aimed to investigate factors affecting N-terminal pro-B-type natriuretic peptide (NTproBNP) in preterm infants and the ability of NTproBNP to predict haemodynamically significant patent ductus arteriosus (HsPDA). Prospective cohort study of 51 infants < 30 weeks gestation. Blood NTproBNP and heart ultrasound were performed on day of life 3, 10, 28 and 36 weeks corrected age. NTproBNP levels analysed for prediction of HsPDA. The effect of gestational age, ventilation, hypoxia, bronchopulmonary dysplasia (BPD), creatinine and haemoglobin levels on NTproBNP levels were investigated. Infants with HsPDA had higher mean (SD) day 3 NTproBNP (1840 pmol/L (1058) versus 178 pmol/L (140) p < 0.001). Receiver operator curves of day 3 NTproBNP for prediction of day 3 and day 10 HsPDA had an area under the curve of 0.98 and 0.94, respectively. A chosen day 3 NTproBNP value of ≥ 287 pmol/L for the prediction of day 3 HsPDA correctly classified 92% (sensitivity 92%, specificity 92%). NTproBNP demonstrated only modest ability to predict severe BPD. Chronological but not gestational age affected NTproBNP. Ventilation, hypoxia and haemoglobin levels did not influence NTproBNP but creatinine level was positively correlated.
Day 3 NTproBNP is a useful biomarker to predict HsPDA and may be a valuable tool in future trial design. What is Known: • NTproBNP is a cardiac hormone used to diagnose and monitor cardiac dysfunction in adults and has been shown to be higher in premature infants with haemodynamically significant ductus arteriosus (HsPDA). What is new: • NTproBNP is highly predictive of ultrasound-defined HsPDA and may be a useful tool for further triage • Early NTproBNP higher in infants who develop severe BPD and with renal impairment but not affected by gestational age, recent exposure to hypoxia or haemoglobin levels while late levels unexpectedly higher in those without BPD or HsPDA.
本研究旨在探讨影响早产儿脑利钠肽前体（NT-proBNP）的因素，以及 NT-proBNP 预测具有血流动力学意义的动脉导管未闭（HsPDA）的能力。
对 51 名胎龄<30 周的早产儿进行前瞻性队列研究。在出生后第 3、10、28 和 36 周校正年龄时进行血 NT-proBNP 和心脏超声检查。分析 NT-proBNP 水平以预测 HsPDA。研究了胎龄、通气、缺氧、支气管肺发育不良（BPD）、肌酐和血红蛋白水平对 NT-proBNP 水平的影响。
具有 HsPDA 的婴儿第 3 天的平均（标准差）NT-proBNP 更高（1840pmol/L（1058）比 178pmol/L（140），p<0.001）。第 3 天 NT-proBNP 预测第 3 天和第 10 天 HsPDA 的受试者工作特征曲线下面积分别为 0.98 和 0.94。第 3 天 NT-proBNP 选择一个≥287pmol/L 的临界值，正确分类了 92%（敏感性 92%，特异性 92%）的第 3 天 HsPDA。NT-proBNP 仅能适度预测严重 BPD。NT-proBNP 受时间影响，不受胎龄影响。通气、缺氧和血红蛋白水平不影响 NT-proBNP，但肌酐水平呈正相关。
第 3 天 NT-proBNP 是预测 HsPDA 的有用生物标志物，可能是未来试验设计的有价值工具。
•NT-proBNP 是一种用于诊断和监测成人心功能障碍的心脏激素，已显示在具有血流动力学意义的动脉导管未闭（HsPDA）的早产儿中更高。
•NT-proBNP 高度预测超声定义的 HsPDA，可能是进一步分类的有用工具。•早期 NT-proBNP 在患有严重 BPD 和肾功能损害的婴儿中更高，但不受胎龄、最近缺氧暴露或血红蛋白水平的影响，而晚期水平出人意料地在没有 BPD 或 HsPDA 的婴儿中更高。
