Serum N-Terminal Pro-B-Type Natriuretic Peptide as a Biomarker of Critical Pulmonary Stenosis in Neonates.

Zhiwei Lin,Hongping Xia,Lin Zhou,Sun Chen,Yanru Chen

doi:10.3389/fped.2021.788715

Abstract

Objectives: To determine the efficacy of serum N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels in predicting critical pulmonary stenosis (CPS) in neonates.Methods: All neonates with pulmonary stenosis (PS) admitted to the neonatal intensive care unit of Xinhua Hospital from October 2014 to December 2020 were retrospectively reviewed. Infants with serum NT-proBNP levels measured within 48 h after birth were enrolled and divided into CPS and non-CPS groups. Serum NT-proBNP levels and cardiac Doppler indices were compared between the two groups. Correlations were determined using the Spearman's rank correlation coefficient. Receiver operator characteristic curve analysis was used to explore the predictive value of NT-proBNP for identifying neonatal CPS.Results: Among 96 infants diagnosed with PS by echocardiography, 46 were enrolled (21 and 25 in the non-CPS and CPS groups, respectively). Serum NT-proBNP levels were significantly higher in the CPS group than in the non-CPS group [3,600 (2,040–8,251) vs. 1,280 (953–2,386) pg/ml, P = 0.003]. Spearman's analysis suggested a positive correlation between Ln(NT-proBNP) levels and the transvalvular pulmonary gradient (r = 0.311, P = 0.038), as well as between Ln(NT-proBNP) levels and pulmonary artery velocity (r = 0.308, P = 0.040). Receiver operating characteristic curve analysis showed that a cutoff serum NT-proBNP level of 2,395 pg/ml yielded a 66.7 and 78.9% sensitivity and specificity for identifying CPS, respectively. The area under the curve was 0.784 (95% CI, 0.637–0.931). A positive correlation was found between Ln(NT-proBNP) and length of hospital stay (r = 0.312, P < 0.05).Conclusion: Serum NT-proBNP level was positively correlated with PS severity and could be used as a biomarker to identify CPS in neonates.

Highlights

Pulmonary stenosis (PS) is a common congenital heart disease characterized by obstruction of the right ventricular outflow tract, accounting for ∼8% of all congenital heart diseases [1]
Critical PS (CPS) is a life-threatening condition in neonates because of inadequate antegrade pulmonary flow through the right ventricular outflow tract, and it presents as cyanosis and evidence of patent ductus arteriosus (PDA) dependency, which can lead to death without timely treatment, given that the ductal shunting decreases progressively [2]
Among 96 newborn infants diagnosed with PS by echocardiography from October 2014 to December 2020 at Xinhua Hospital, 33 had serum NT-proBNP levels measured over 48 h after birth, the remaining 63 patients had a gestational age over 34 weeks, 1 had PS and ventricular septal defect (VSD), 2 had pulmonary atresia (PA), 11 had other complex congenital heart diseases (1 with right ventricular diverticulum, 4 with double outlet right ventricle, 3 with complete transposition of the great artery, 1 with single ventricle, 1 with aortic stenosis, and 2 with severe TR), 1 had severe pleural effusion and ascites, and 1 had missing data

Summary

Introduction

Pulmonary stenosis (PS) is a common congenital heart disease characterized by obstruction of the right ventricular outflow tract, accounting for ∼8% of all congenital heart diseases [1]. Critical PS (CPS) is a life-threatening condition in neonates because of inadequate antegrade pulmonary flow through the right ventricular outflow tract, and it presents as cyanosis and evidence of patent ductus arteriosus (PDA) dependency, which can lead to death without timely treatment, given that the ductal shunting decreases progressively [2]. Prostaglandin E1 (PGE1) should be administered in time to maintain the open ductus arteriosus, increase the pulmonary artery blood flow, and improve hypoxemia. To the best of our knowledge, no recognized and definite biochemical indicators have been reported to date to assess the severity of PS in neonates. A widely feasible biomarker would greatly benefit the promotion of early diagnosis and treatment of CPS, especially in situations wherein bedside echocardiography is not immediately available

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