Value of B-type natriuretic peptide in diagnosis and treatment of haemodynamically significant patent ductus arteriosus in early preterm infants

Abstract

Objective To analyze the value of B-type natriuretic peptide (BNP) in the diagnosis and treatment of haemodynamically significant patent ductus arteriosus (hsPDA) in the early preterm infants. Methods The 271 early preterm infants (gestational age <34 weeks) admitted to NICU of the Affiliated Xuzhou Hospital of Southeast University from January 2012 to May 2015 chosen by adoption standards were divided into the hsPDA group (63 cases), the non-hsPDA group (nhsPDA group, 82 cases) and the non-patent ductus arteriosus group (nPDA group, 126 cases) (hsPDA︰nPDA=1︰2). The plasma BNP was tested on 2-3 d after birth, and the echocardiography was done on 3-7 d after birth which was reexamined at 72 h after drug treatment in hsPDA group.SPSS 20.0 software was used for data analysis. Results There was significant difference in plasma BNP levels between the hsPDA group [572 (251, 924) ng/L] and nhsPDA group [171 (147, 541) ng/L] and also between hsPDA group and nPDA group [188 (141, 250) ng/L](Z=-4.069, -6.365; P=0.000, 0.000), but there was no significant difference between nhsPDA group and nPDA group(Z=-1.674, P=0.094). The area under receiver operating characteristic (ROC) curve of the plasma BNP levels for prediction of hsPDA in the early preterm infants on 2-3 d after birth was 0.750 (95%CI 0.672-0.828), and it has statistical significance(P=0.000). The optimal boundary value of the plasma BNP levels was 292.5 ng/L, sensitivity was 75.4% and specificity was 77.6%, respectively.There was no statistical significance of the area under the ROC curve of the plasma BNP levels, which predicted the area under the ROC curve after drug treatment failure for hsPDA in preterm infants was 0.540 (95%CI 0.351-0.729). There was significantly positive correlation between the plasma BNP levels on 2-3 d after birth and the arterial flow (left atrial diameter/aortic diameter) and diameter of the ductus arteriosus(partial correlation coefficients=0.365, 0.370; P=0.000, 0.000). Conclusions The plasma BNP levels of early preterm infants on 2-3 d after birth can help predict the probability of hsPDA occurrence in preterm infants, and is significantly positively correlated with the magnitudes of the ductal shunt and the diameter of the ductus arteriosus, but it can not help predict the probability of failure of drug treatment for hsPDA well.The rang of the plasma BNP levels is too large with skewed distribution, which affects its value of clinical application in the diagnosis and treatment of hsPDA in the early preterm infants. Key words: B-type natriuretic peptide; Patent ductus arteriosus; Receiver operating characteristic curve; Infant, preterm