Value of N-terminal pro-brain natriuretic peptide on evaluating heart failure in neonates with respiratory distress syndrome

Abstract

Objective To explore the value of plasma N-terminal pro-brain natriuretic peptide(NT-proBNP) in diagnosing or excluding concurrent heart failure (HF) in neonates with respiratory distress syndrome (RDS). Methods One hundred and fifteen preterm infants with RDS, admitted to Neonatal Intensive Care Unit of the First Affiliated Hospital of Zhengzhou University from Jan.2011 to Oct.2012, were classified into 2 groups: HF group (56 cases) and non-HF group (59 cases). Differences in cardiac biomarkers and parameters of ultrasonic cardiogram for cardiac function between the 2 groups were analyzed within 24 hours after birth through univariate factors.To evaluate independent factors for HF, logistic regression analysis was performed including significant univariate factors.Receiver operator characteristic curve (ROC) was used to determine the best cutoff for diagnosis of HF with sensitivity and specificity of more than 90%. Results The level of plasma troponin and CK-MB showed no significant difference between the 2 groups(all P>0.05). Compared with the non-HF group, the incidence of patent ductus arteriosus, patent foramen ovale and pulmonary hypertension, as well as plasma NT-proBNP level and pulmonary artery pressure were significantly higher in the HF group(all P<0.05). In contrast, left ventricular ejection fraction and E/A ratio were significantly lower in the HF group(all P<0.05). Logistic regression analysis, which was performed using the 7 significant univariate factors, showed that only plasma NT-proBNP was the independent factor for evaluating HF(OR=1.359, P=0.000). The area under ROC for NT-proBNP levels for diagnosis of HF in RDS neonates was 0.997 (95% CI 0.962-1.000, P=0.000). A cutoff value of at least 16 379 ng/L had a sensitivity of 91.1% and specificity of 98.3%.All the 8 neonates who died had a plasma NT-proBNP level of 35 000 ng/L in 24 hours after birth, significantly higher than that in survival neonates(P=0.000). Conclusions Plasma NT-proBNP level proved to have the value for independently determining or excluding HF in RDS neonates, and dynamic observation for NT-proBNP level may be used for early prediction of mortality risk in neonates with HF. Key words: Respiratory distress syndrome; N-terminal pro-brain natriuretic peptide; Heart failure; Diagnosis