Gudmundsdottir Anna, Bartocci Marco, Picard Oda, Ekström Joanna, Chakhunashvili Alexander, Bohlin Kajsa, Attner Caroline, Printz Gordana, Karlsson Mathias, Mohlkert Lilly-Ann, Karlén Jonna, Pegelow Halvorsen Cecilia, Edstedt Bonamy Anna-Karin
Department of Women's and Children's Health, Karolinska Institutet, 171 77 Stockholm, Sweden.
Department of Neonatology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, 171 64 Stockholm, Sweden.
J Clin Med. 2022 Jan 27;11(3):667. doi: 10.3390/jcm11030667.
The aim was to investigate the association of gestational age (GA), echocardiographic markers and levels of plasma N-terminal pro-B-type natriuretic peptide (NTproBNP) with the closure rate of a haemodynamically significant patent ductus arteriosus (hsPDA). Ninety-eight Swedish extremely preterm infants, mean GA 25.7 weeks (standard deviation 1.3), born in 2012-2014, were assessed with echocardiography and for levels of NTproBNP. Thirty-three (34%) infants had spontaneous ductal closure within three weeks of age. Infants having spontaneous closure at seven days or less had significantly lower NTproBNP levels on day three, median 1810 ng/L (IQR 1760-6000 ng/L) compared with: infants closing spontaneously later, 10,900 ng/L (6120-19,200 ng/L); infants treated either with ibuprofen only, 14,600 ng/L (7740-28,100 ng/L); or surgery, 32,300 ng/L (29,100-35,000 ng/L). Infants receiving PDA surgery later had significantly higher NTproBNP values on day three than other infants. Day three NTproBNP cut-off values of 15,001-18,000 ng/L, predicted later PDA surgery, with an area under the curve in ROC analysis of 0.69 (0.54-0.83). In conclusion, the spontaneous PDA closure rate is relatively high in extremely preterm infants. Early NTproBNP levels can be used with GA in the management decisions of hsPDA.
目的是研究胎龄（GA）、超声心动图标志物及血浆N末端B型脑钠肽原（NTproBNP）水平与血流动力学显著的动脉导管未闭（hsPDA）闭合率之间的关联。对98例2012 - 2014年出生的瑞典极早产儿进行了评估，其平均胎龄为25.7周（标准差1.3），接受了超声心动图检查及NTproBNP水平检测。33例（34%）婴儿在3周龄内实现了动脉导管自发闭合。在7天及以内实现自发闭合的婴儿在第3天的NTproBNP水平显著低于：自发闭合较晚的婴儿，为10900 ng/L（6120 - 19200 ng/L）；仅接受布洛芬治疗的婴儿，为14600 ng/L（7740 - 28100 ng/L）；或接受手术治疗的婴儿，为32300 ng/L（29100 - 35000 ng/L）。接受PDA手术较晚的婴儿在第3天的NTproBNP值显著高于其他婴儿。第3天NTproBNP截断值为15001 - 18000 ng/L时，可预测后期PDA手术，ROC分析曲线下面积为0.69（0.54 - 0.83）。总之，极早产儿中PDA自发闭合率相对较高。早期NTproBNP水平可与胎龄一起用于hsPDA的管理决策。
