Department of Neonatology and Pediatric Intensive Care Medicine, University of Bonn, Germany.
Institute for Clinical Chemistry and Clinical Pharmacology, University of Bonn, Bonn, Germany; Institute for Laboratory Medicine, German Heart Center of the State of Bavaria and the Technical University Munich, Germany.
Early Hum Dev. 2020 Jul;146:105049. doi: 10.1016/j.earlhumdev.2020.105049. Epub 2020 Apr 25.
Severity of lung hypoplasia, pulmonary hypertension (PH) and cardiac dysfunction are major contributors to mortality in congenital diaphragmatic hernia (CDH). Therefore, early assessment and management is important to improve outcome. NT-proBNP is an established cardiac biomarker with only limited data for early postnatal risk assessment in CDH newborns.
To investigate the correlation of NT-proBNP at birth, 6 h, 12 h, 24 h, and 48 h with PH and cardiac dysfunction and the prognostic information of NT-proBNP for the use of ECMO support or mortality.
44 CDH newborns treated at our institution (December 2014-October 2017) were prospectively enrolled.
Primary clinical endpoint was either need for ECMO or death within the first 48 h (group A). Infants not receiving ECMO support were allocated to group B. Mortality was tested as secondary endpoint.
NT-proBNP levels measured at 6 h, 12 h, 24 h and 48 h postpartum correlated significantly with PH severity following NICU admission and at 24 h, and with severity of cardiac dysfunction at birth, 24 h, 48 h and after 7 days of life. There was no difference in NT-proBNP levels between survivors and non-survivors. NT-proBNP levels were significantly higher in group A at 6 h (p = 0.007), 12 h (p = 0.036), and 24 h (p = 0.007), but not at birth (p = 0.785) or 48 h (p = 0.15) compared to group B.
NT-proBNP analysis in the first 48 h of life may be useful to assess PH and cardiac dysfunction in CDH newborns and to predict the need for ECMO support.
肺发育不全的严重程度、肺动脉高压（PH）和心功能障碍是先天性膈疝（CDH）患儿死亡的主要原因。因此，早期评估和管理对于改善预后非常重要。NT-proBNP 是一种已被确立的心脏生物标志物，但其在 CDH 新生儿出生后早期风险评估中的应用数据有限。
探讨 NT-proBNP 在出生时、出生后 6 小时、12 小时、24 小时和 48 小时与 PH 和心功能障碍的相关性，以及 NT-proBNP 对 ECMO 支持或死亡率的预后信息。
本机构于 2014 年 12 月至 2017 年 10 月期间前瞻性纳入的 44 例 CDH 新生儿。
主要临床终点为出生后 48 小时内需要 ECMO 支持或死亡（A 组）。未接受 ECMO 支持的患儿被分配到 B 组。死亡是次要终点。
出生后 6 小时、12 小时、24 小时和 48 小时测量的 NT-proBNP 水平与 NICU 入院时和 24 小时时 PH 严重程度以及出生时、24 小时、48 小时和出生后 7 天时心功能障碍的严重程度显著相关。存活组和死亡组之间的 NT-proBNP 水平无差异。A 组在 6 小时（p=0.007）、12 小时（p=0.036）和 24 小时（p=0.007）时的 NT-proBNP 水平显著高于 B 组，但在出生时（p=0.785）或 48 小时（p=0.15）时无差异。
出生后 48 小时内的 NT-proBNP 分析可能有助于评估 CDH 新生儿的 PH 和心功能障碍，并预测 ECMO 支持的需求。
