We report a blinded, prospective study of the diagnostic
utility of
N-terminal pro-brain natriuretic
peptide (NTproBNP) measurements for predicting clinically significant
patent ductus arteriosus (PDA) and assessing closure. METHODS: Plasma NTproBNP was measured during the first week in 100
preterm babies (
mean gestation 28.8 +/- 2.9 weeks;
mean birth weight 1224 +/- 512 g).
Echocardiography was performed between days 5 and 7 by operators, blinded to NTproBNP concentration. RESULTS: NTproBNP peaked on days 2 and 3, declined by day 7. Twenty babies, later treated for PDA, had significantly higher NTproBNP levels throughout. Areas under
receiver operating characteristic (ROC) curves were 0.896, 0.897 and 0.931 on days 2, 3 and 7, respectively (p < 0.0001). A concentration > 2850 pmol/L had diagnostic sensitivity of 90% and specificity of 89% (95% CI: 68, 99;
likelihood ratio 8.10).
Ductal closure was associated with a fall in
mean NTproBNP from 3003 to 839 pmol/L (p < 0.001). CONCLUSION:
N-terminal pro B-type
brain natriuretic peptide (NTproBNP) concentrations peaked and then declined in the first week but remained higher in
preterm babies whose PDA required treatment. NTproBNP on day 3 predicted whether a neonatal physician blinded to results would treat a PDA. Fall in plasma NTproBNP indicated closure.
