206 Nt Pro-Bnp, Ngal, and H-Fabp are Indicators of Hemodynamic Relevance of Patent Ductus Arteriosus in Preterm Infants

Abstract

Background and aims: Patent ductus arteriosus (PDA) is the most common functional cardiovascular disease of preterm infants. Hemodynamic relevance for organs and circulation can neither be derived from clinical nor from echocardiographic criteria. The aim of the present study was to establish non-invasive parameters which reflect perfusion-dependent consequences of the ductus for the organism of the preterm infant. Methods: Urinary protein levels of NT pro-BNP, NGAL, and H-FABP were measured and correlated with the necessity of therapeutic interventions for PDA. In a group of 38 preterm infants with a birth weight of less than 1500g, the protein concentrations in urine were tested on day 0-1, 2-4, and 6-8 by ELISA methodology. 12 of 38 infants required therapeutic interventions according to current treatment standards. Results: Infants receiving an intervention for PDA (either ibuprofen treatment of ligation) showed significantly higher levels of NT pro-BNP, NGAL, and H-FABP at all time points except for NT pro-BNP on day 0. Infants requiring a second or third course of ibuprofen had significantly higher levels of H-FABP and NGAL. In all samples the concentration of the three proteins NT pro-BNP, NGAL, and H-FABP correlated positively with each other. Conclusions: The present study shows that measurement of urinary proteins is a powerful and non-invasive method to quantify the effect of the PDA on the organism in preterm infants. Furthermore our data show that NGAL and H-FABP can be used to predict the necessity of pharmaceutical or surgical treatment of PDA.