Abstract
BackgroundPatent ductus arteriosus (PDA) is a common complication in very preterm infants. It is known that there is an association between PDA and development of bronchopulmonary dysplasia (BPD) or death before the postmenstrual age (PMA) of 36 weeks, but this association remains one of the most controversial aspects of the problem. The study aimed to evaluate the relationship between PDA, serum NT-proBNP levels at 2–3 and 8–9 days of life, and BPD/death in very preterm infants.MethodsData of 52 preterm infants with a gestational age < 32 weeks, chronological age < 72 h, and PDA diameter > 1.5 mm, enrolled in a randomized controlled trial, were used for the retrospective analysis. All patients underwent daily echocardiographic and two serum NT-proBNP measurements within the first 10 days after birth. Two groups of infants were formed retrospectively at PMA of 36 weeks depending on the outcome, BPD (n = 18)/death (n = 7) or survival without BPD (n = 27). Receiver operator characteristic (ROC) curve was used to evaluate the predictive performance of serum NT-proBNP levels for BPD/death occurrence.ResultsThe percentage of infants who received pharmacological treatment for PDA did not differ between the groups. Based on the area under the ROC curve, serum NT-proBNP levels on the 2–3 day of life (AUC = 0.71; 95% confidence interval (CI): 0.56–0.9; p = 0.014)) and on the 8–9 day of life (AUC = 0.76; 95% CI: 0.6–0.9; p = 0.002) could reliably predict BPD/death in very preterm infants who had PDA diameter > 1.5 mm in the first 72 h of life. Hemodynamically significant PDA (hsPDA) was significantly more often detected in newborns with BPD/death, however, treatment of infants with hsPDA did not reduce the incidence of BPD/death.ConclusionsIn very preterm infants with PDA > 1.5 mm at the age of 24–48 h, serum NT-proBNP concentration could reliably predict the development of BPD or death, regardless of the persistence of PDA, with the highest diagnostic value at 8–9 days.Trial registrationThis study is registered in ClinicalTrials.gov - NCT03860428 on March 4, 2019.
Highlights
Patent ductus arteriosus (PDA) is a common complication in very preterm infants
The results of this study showed that infants who died or developed bronchopulmonary dysplasia (BPD) significantly more often had Hemodynamically significant patent ductus arteriosus (hsPDA) than babies who survived without BPD
Our results indicate that early NT-proBNP screening could reduce the workload and resource utilization associated with PDA assessment in very preterm infants, especially in settings with limited access to around-the-clock echocardiography expertise, and significantly limit the presence of subjectivity component within that assessment
Summary
It is known that there is an association between PDA and development of bronchopulmonary dysplasia (BPD) or death before the postmenstrual age (PMA) of 36 weeks, but this association remains one of the most controversial aspects of the problem. It is known that there is an association between PDA and the risk of bronchopulmonary dysplasia (BPD) developing and/or death before 36 weeks of postmenstrual age (PMA). The most important risk factor for BPD is gestational age, but almost a third of extremely preterm infants do survive without the disease [10]. The search for additional prognostic criteria that would help to solve this problem is still ongoing Among such criteria, important attention is paid to biomarkers pathogenetically related to the development of BPD, the advantage of which is objectivity and feasibility. The diagnostic value of many tested biomarkers remains insufficient, mandating the need for reliable early indicators of BPD development [11]
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