Abstract
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.
Highlights
In extremely preterm infants, diagnostic and treatment strategies of a haemodynamically significant patent ductus arteriosus have changed, with fewer infants treated and at a later postnatal age [1]
Treated for a haemodynamically significant patent ductus arteriosus (hsPDA), 36 (62%) were treated with ibuprofen only, 17 (29%) with ibuprofen followed by later PDA surgery and five (9%) with primary PDA surgery, Table 1
Of the fifty-three infants treated with ibuprofen, 28 (53%) were treated at seven days of age or less, median five days (IQR 5–6), and 25 (47%) were treated at more than seven days of age, median 11 days (IQR 10–12)
Summary
Diagnostic and treatment strategies of a haemodynamically significant patent ductus arteriosus (hsPDA) have changed, with fewer infants treated and at a later postnatal age [1]. The definition of a hsPDA has varied between studies and many studies lacked longitudinal echocardiographic data and thereby knowledge about the duration of the PDA shunt [4,5]. The evidence for different PDA treatment strategies is weak and data on the association with later outcomes is limited [6]. The predictive value of clinical and echocardiographic markers of ductal severity has been studied in association with adverse outcome, and the additive role of the cardiac biomarkers suggested a possible importance of N-terminal pro B-type natriuretic peptide (NTproBNP) [10,11,12,13]
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