Abstract
Hemodynamically significant patent ductus arteriosus (hsPDA) in preterm infants is a common and important problem associated with significant morbidity and mortality including: intraventricular hemorrhage, necrotizing enterocolitis and bronchopulmonary dysplasia. The rapid and accurate determination of the indications for therapeutic closure of hsPDA in preterm infants is important but often difficult. Currently used tools, such as the clinical findings, including heart failure and the typical echocardiographic features of hsPDA, have unsatisfactory sensitivity and/or specificity. Over the last decade, measurement of plasma B-type natriuretic peptide (BNP) levels using a commercially available bedside testing kit has been proposed to aid in the diagnosis and treatment of hsPDA in preterm infants. The present review analyzes the clinical usefulness of a rapid plasma BNP assay for the management of hsPDA in preterm infants and speculates on potential future therapeutic directions, including predicting subsequent hsPDA for early targeted treatment and predicting of treatment response for decision-making regarding surgical intervention before and after medical treatments.
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