Effectiveness of B-type Natriuretic Peptide in Caring for Preterm Infants

Narae Lee; Mi-hye Bae; Young-Mi Han; Kyung-Hee Park; Shin-Yun Byun

doi:10.14734/PN.2018.29.02.78

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Lee, Bae, Han, Park, and Byun: Effectiveness of B-type Natriuretic Peptide in Caring for Preterm Infants

Original Article

Perinatology 2018;29(2):78-82.

Published online: 19 June 2018

DOI: https://doi.org/10.14734/PN.2018.29.02.78

Effectiveness of B-type Natriuretic Peptide in Caring for Preterm Infants

Narae Lee, MD, Mi-hye Bae, MD, Young-Mi Han, MD, PhD, Kyung-Hee Park, MD, Shin-Yun Byun, MD, PhD

Department of Pediatrics, Pusan National University School of Medicine, Yangsan, Korea

Correspondence to Shin-Yun Byun, MD, PhD Department of Pediatrics, Pusan National University Children's Hospital, 20 Geumo-ro, Yangsan 50612, Korea Tel: +82-55-360-2180 Fax: +82-55-360-2181 E-mail: byun410@hanmail.net

Received 8 May 201720 September 2017 Accepted 12 March 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objective

Volume and pressure loading of the ventricles are associated with increased plasma B-type natriuretic peptide (BNP) levels. Hemodynamically significant patent ductus arteriosus (hsPDA) is a risk factor for life-threatening conditions in preterm infants. We compared follow-up data such as echocardiograms, BNP levels, comorbidities, and prognosis in preterm infants with PDA, and investigated the relationship between maternal prenatal factors and BNP.

Methods

This single-center study performed between January 2015 and August 2016 included 63 preterm infants with a gestational age of <35 weeks. We retrospectively evaluated the BNP levels on postnatal day 1, 3, and 7, clinical features, treatment method for PDA, mortality, and maternal prenatal factors.

Results

Lower gestational age and smaller birth weight were associated with a higher incidence of hsPDA (P<0.01). Postnatal day 3 BNP levels were significantly higher in the hsPDA group. BNP levels were not associated with failure of medication in the hsPDA group. Postnatal day 1 BNP levels were associated with an abnormal umbilical artery flow (P=0.017), and deceleration in fetal non-stress test result (P=0.01) but not with other maternal states.

Conclusion

BNP levels are a useful predictive biomarker for hsPDA in preterm infants during the 3rd days of life; however, they do not help in decision-making regarding treatment. BNP levels on the 1st postnatal day showed a positive correlation with prenatal factors such as abnormal umbilical artery flow and deceleration in fetal NST result.

Keywords: Brain natriuretic peptide, Patent ductus arteriosus, Premature infant

REFERENCES

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Table 1.

Comparison of the Clinical Characteristics between Preterm Infants with and without hs Patent Ductus Arteriosus

	nhsPDA (n=28)	hsPDA (n=35)	Total (n=63)	P-value
Male	15 (53.6)	18 (51.4)	33 (52.4)	1.00
Gestational age (wks)	32.4±2.6	29.1±3.6	30.6±3.5	0.00
Birth weight (g)	1,975.0	930.0	1,460.0	0.00
	(1,465.0, 2,180.0)	(715.0, 1,525.0)	(780.0, 1,975.0)
IUGR	3 (10.7)	12 (34.3)	15 (23.8)	0.06
Platelet (/μL)	209.2±70.8	206.3±85.2	207.6±78.5	0.88
Treatment
Ibuprofen	0 (0.0)	33 (94.3)	33 (52.4)	0.00
Surgical ligation	0 (0.0)	11 (31.4)	11 (17.5)	0.00
Death	1 (3.6)	13 (37.1)	14 (22.2)	0.00

Values are presented as number (%), mean±standard deviation, or median with interquartile range. Abbreviations: hs, hemodynamically significant; nhs, non hemodynamically significant; PDA, patent ductus arteriosus; IUGR, intrauterine growth retardation.

Table 2.

Changes of B-type Natriuretic Pepetide in Preterm Infant with nhs Patent Ductus Arteriosus and hs Patent Ductus Arteriosus

BNP (pg/mL)	nhsPDA (n=28)	hsPDA (n=35)	Total (n=63)	P-value
Day 1	204.5 (143.5, 359.0)	212.0 (117.5, 670.5)	211.0 (133.0, 612.0)	0.917
Day 3	426.0 (266.0, 1475.5)	2760.0 (889.5, 4835.5)	1385.0 (369.0, 3783.5)	0.001
Day 7	76.0 (37.0, 185.5)	261.0 (125.5, 1173.5)	188.0 (65.0, 568.0)	0.000

Values are presented as median with interquartile range. Abbreviations: nhs, non hemodynamically significant; hs, hemodynamically significant; BNP, B-type natriuretic peptide; Day, postnatal day.

Table 3.

Descriptive Characteristics of Preterm Infant with Patent Ductus Arteriosus According to Treatment

	Ibuprofen (n=24)	Surgical ligation (n=11)	Total (n=35)	P-value
Male	10 (41.7)	8 (72.7)	18 (51.4)	0.179
Gestational age (wks)	29.9±3.3	27.5±3.6	30.6±3.5	0.055
Birth weight (g)	1,238.3±530.7	857.3±382.7	1,467.9±660.0	0.040
IUGR	8 (33.3)	4 (36.4)	12 (34.3)	0.787
Platelet (/μL)	199.0±84.0	222.2±89.7	207.6±78.5	0.463
BNP (pg/mL)
Day 1	183.0 (93.5, 612.0)	434.0 (169.5, 735.0)	211.0 (133.0, 612.0)	0.256
Day 3	1,712.0 (506.5, 4,575.5)	4,787.0 (2,835.0, 4,901.0)	1,385.0 (369.0, 3,783.5)	0.114
Death	5 (20.8)	8 (72.7)	13 (37.1)	0.010

Values are presented as number (%), mean±standard deviation, or median with interquartile range. Abbreviations: IUGR, intrauterine growth retardation; BNP, B-type natriuretic peptide; Day, postnatal day.

Table 4.

Compare the First Postnatal Day B-type Natriuretic Peptide in Preterm Infant with Patent Ductus Arteriosus by Perinatal Factors

	Absent	Present	P-value
PROM	212.0 (128.0, 586.0) (n=45)	204.5 (151.0, 773.0) (n=18)	0.568
Preeclampsia	203.5 (129.0, 541.0) (n=52)	213.0 (155.0, 667.5) (n=11)	0.745
Gestational DM	203.5 (130.0, 644.0) (n=58)	283.0 (217.0, 434.0) (n=5)	0.611
Fetal deceleration in NST	175.0 (122.0, 312.0) (n= 49)	909.0 (282.0, 2,900.0) (n=14)	0.001
Abnormal umbilical flow	187.0 (125.0, 340.0) (n=52)	2,900.0 (454.5, 4,644.0) (n=11)	0.013

Values are presented as median with interquartile range. Abbreviations: PROM, premature rupture of amniotic membrane; DM, diabetes mellitus; NST, non-stress test.

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