N‐terminal‐probrain natriuretic peptide as a biomarker of moderate to severe bronchopulmonary dysplasia in preterm infants: A prospective observational study

• Published in: Pediatric pulmonology 2018-08, Vol.53 (8), p.1073-1081
• Main Authors: Rodríguez‐Blanco, Silvia, Oulego‐Erroz, Ignacio, Alonso‐Quintela, Paula, Terroba‐Seara, Sandra, Jiménez‐González, Aquilina, Palau‐Benavides, Maite
• Format: Article
• Language: English
• Subjects: biomarkers; Biomarkers - blood; brain natriuretic peptides; bronchopulmonary dysplasia; Bronchopulmonary Dysplasia - diagnosis; Bronchopulmonary Dysplasia - mortality; Congenital diseases; Coronary vessels; Enterocolitis, Necrotizing - mortality; Female; Humans; Hypertension, Pulmonary - mortality; Infant; Infant, Newborn; Infant, Premature; Infant, Very Low Birth Weight; Intracranial Hemorrhages - mortality; Lung diseases; Male; Natriuretic Peptide, Brain - blood; Newborn babies; Observational studies; Peptide Fragments - blood; Premature babies; preterm; Prospective Studies; Respiratory Insufficiency - mortality; Sensitivity and Specificity; Sepsis - mortality
• ISSN: 8755-6863; 1099-0496
• DOI: 10.1002/ppul.24053

Objective N‐terminal‐probrain natriuretic peptide (NT‐proBNP) is a marker of hemodynamically significant patent ductus arteriosus (HsPDA) in preterm infants. In this study, we assessed whether NT‐proBNP levels could predict the risk of moderate to severe bronchopulmonary dysplasia (BPD) and/or death. Methods This was an observational prospective study of preterm infants with GA ≤32 weeks. Infants who died within the first 48 h or who had major congenital malformations or incomplete information were excluded. NT‐proBNP was determined at 48‐96 h of life and at 5‐10 days of life. The predictive capacity of NT‐proBNP for the combined outcome of BPD and/or death was evaluated using receiver operator characteristic (ROC) curves and multivariate regression. Results Of the 125 eligible patients, 110 completed the analysis. Twenty‐eight developed BPD (n = 15) and/or died (n = 13). Infants who developed BPD and/or died had higher NT‐proBNP levels ​​at 48‐96 h (26,848 ng/L, interquartile range [IQR] 7818‐60,684 vs 3008 ng/L, IQR 1425‐9876) and at 5‐10 days (8849 ng/L, IQR 3796‐19,526 vs 1427 ng/L, IQR 907‐2889). The NT‐proBNP levels at 5‐10 days, but not at 48‐96 h, were independently associated with BPD and/or death after adjustments for HsPDA and other confounders (OR = 3.36; 95%CI: 1.52‐7.4, P = 0.006). For the prediction of this result, a cutoff of 3348 ng/L had a sensitivity and specificity of 82% and 83%, respectively (area under the curve [AUC] = 0.87; 95%CI: 0.79‐0.95). Conclusion The NT‐proBNP levels at 5‐10 days of life may identify preterm infants with an HsPDA who are at high risk of BPD or death and may be useful for individualized preventive and therapeutic strategies.