142 B-Type Natriuretic Peptide as Early Biomarker for Evaluation of Persistent Pulmonary Hypertension Treatment in Neonates

Abstract

Background: During persistent pulmonary hypertension (PPHN) the pulmonary vascular resistance remains elevated in the neonatal period. Treatment is directed towards decreasing the pulmonary vascular resistance (Nitric Oxide (NO)) and preserving adequate blood pressure. Besides regular echocardiographic evaluation, no biomarker is available to evaluate the effectiveness of the treatment.We investigated whether serum B-type Natriuretic Peptide (BNP) is a useful biomarker to evaluate the course of PPHN and effectiveness of treatment.Design/methods: 24 patients with PPHN were treated. Serum BNP levels were determined longitudinally. 3 patients were excluded because of the need for ECMO. In 6 patients a rebound of PPHN occurred after treatment was terminated. BNP levels were compared between infants with or without rebound PPHN (n=15).Results: All PPHN infants had similar BNP levels at the start of initial NO. BNP levels decreased in both groups during NO treatment. In the infants who developed a rebound PPHN an increase was found in BNP shortly after cessation of NO treatment. This occurred well before the onset of clinical deterioration. BNP again decreased significantly during NO treatment (p< 0.05). Figure 1 provides the course of BNP.?emptypara?Conclusion: BNP, as a biomarker of cardiac ventricular strain, proved to be useful in evaluating the course and treatment of PPHN and can serve as a predictor of rebound PPHN.