Abstract
The aim of our study was to observe the temporal distribution of serum N-terminal pro-brain natriuretic peptide (NT-proBNP) in premature infants of ≤ 31 weeks of gestational age (GA) during the first weeks of life. NT-proBNP values of 118 preterm infants born ≤ 31 weeks GA were determined during the first week of life, after 4 ± 1 weeks of life, and at a corrected GA of 36 ± 2 weeks. Infants were divided into two groups: those without relevant complications and those with complications related to prematurity. NT-proBNP values of infants without complications define our exploratory reference values. The Median NT-proBNP level of these infants was 1896 ng/l (n = 27, interquartile range (IQR): 1277–5200) during the first week of life, 463 ng/l (n = 26, IQR: 364–704) at 4 ± 1 weeks of life, and 824 ng/l (n = 33, IQR: 714–1233) at a corrected GA of 36 ± 2 weeks. Infants born < 28 + 0 weeks GA had significantly higher NT-proBNP values (n = 9, median: 5200, IQR: 1750–8972) than infants born ≥ 28 + 0–31 weeks GA (n = 18, median: 1528, IQR: 838–3052; p = 0.017). Growth restriction or PDA status could not account for the difference in NT-proBNP values between GA groups.Conclusions: The results of our observational and cross-sectional study describe exploratory reference values for NT-proBNP levels in preterm infants of ≤ 31 weeks GA according to postnatal age. NT-proBNP levels during the first week of life are high and widely distributed in preterm infants and decrease subsequently to reach a distinctly lower and stable plateau at around 1 month of life. Our results suggest an influence of GA on NT-proBNP values in the first week of life.What is Known:• Several complications related to prematurity, e.g., hemodynamically significant PDA, pulmonary hypertension, bronchopulmonary dysplasia, and retinopathy of prematurity, have been associated with a temporary rise in NT-proBNP values in preterm infants during their first weeks of life.What is New:• This observational study provides reference values for NT-proBNP levels of very and extremely preterm infants during their first weeks of life.• In premature infants without complications, NT-proBNP values during their first week of life depend on gestational age at birth.
Highlights
Brain natriuretic peptide (BNP) consists of 32 amino acids, is predominantly produced in cardiomyocytes of the ventricles of the heart, and is secreted in response to cardiac stress, e.g., to volume expansion or pressure overload to regulate blood pressure by increasing diuresis, natriuresis, and vasodilation
The results of our observational and cross-sectional study describe exploratory reference values for NT-proBNP levels in preterm infants of ≤ 31 weeks gestational age (GA) according to postnatal age
Our results suggest an influence of GA on NT-proBNP values in the first week of life
Summary
Brain natriuretic peptide (BNP) consists of 32 amino acids, is predominantly produced in cardiomyocytes of the ventricles of the heart, and is secreted in response to cardiac stress, e.g., to volume expansion or pressure overload to regulate blood pressure by increasing diuresis, natriuresis, and vasodilation. NT-proBNP is associated with different diseases of prematurity; increased NT-proBNP and BNP levels have been found in infants with hemodynamically significant patent ductus arteriosus (hsPDA) [6,7,8,9], bronchopulmonary dysplasia (BPD) [10,11,12,13,14,15], pulmonary hypertension (PH) [16,17,18,19,20,21,22], retinopathy of prematurity (ROP) [23, 24], inflammation or sepsis [25,26,27], and congenital heart diseases [28, 29], but published data remain inconclusive
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