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Am J Perinatol 2010; 27(5): 381-386
DOI: 10.1055/s-0029-1243312
© Thieme Medical Publishers

N-terminal pro-B-type Natriuretic Peptide as a Marker of Bronchopulmonary Dysplasia in Premature Infants

Leon Joseph1 , Amiram Nir2 , Cathy Hammerman3 , Shmuel Goldberg1 , Efrat Ben Shalom1 , Elie Picard1
  • 1Department of Pediatric Pulmonology, Shaare Zedek Medical Center, Jerusalem and the Hebrew University, School of Medicine, Jerusalem, Israel
  • 2Department of Pediatric Cardiology, Shaare Zedek Medical Center, Jerusalem and the Hebrew University, School of Medicine, Jerusalem, Israel
  • 3Department of Neonatology, Shaare Zedek Medical Center, Jerusalem and the Hebrew University, School of Medicine, Jerusalem, Israel
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Publication History

Publication Date:
11 December 2009 (online)

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ABSTRACT

We performed an observational pilot study of plasma concentrations of N-terminal pro-B-type natriuretic peptide (BNP) in premature infants with a diagnosis of bronchopulmonary dysplasia (BPD) at 4 weeks of age and after 1 month of conventional therapy. Thirty-four premature infants born before 34 weeks' gestational age without cardiac or infectious diseases were included. Serum NT-pro-BNP was measured in all neonates at 4 weeks of age. In infants with the diagnosis of BPD (n = 11), measurements were repeated at 6 and 8 weeks of age under conventional treatment. Specific clinical characteristics were collected prospectively. Baseline NT-pro-BNP concentrations were high in healthy premature infants compared with previously reported healthy neonates, and significantly higher in those who developed BPD. There was a significant correlation between concentrations of NT-pro-BNP and severity of respiratory distress as assessed by several methods. The concentrations of NT-pro-BNP decreased significantly over time in BPD infants. Premature infants have high concentrations of NT-pro-BNP at 1 month of age. NT-pro-BNP concentrations are significantly higher in BPD infants and decline over time. NT-pro-BNP concentrations correlate with clinical severity of respiratory disease.

KEYWORDS

Bronchopulmonary dysplasia - natriuretic peptides - prematurity

REFERENCES

  • 1 Egreteau L, Pauchard J Y, Semama D S et al.. Chronic oxygen dependency in infants born at less than 32 weeks' gestation: incidence and risk factors.  Pediatrics. 2001;  108 E26
    CrossrefPubMedGoogle Scholar
  • 2 Adams E W, Harrison M C, Counsell S J et al.. Increased lung water and tissue damage in bronchopulmonary dysplasia.  J Pediatr. 2004;  145 503-507
    Google Scholar
  • 3 Brion L P, Primhak R A, Ambrosio-Perez I. Diuretics acting on the distal renal tubule for preterm infants with (or developing) chronic lung disease.  Cochrane Database Syst Rev. 2000;  (1) CD001817
    PubMedGoogle Scholar
  • 4 Brion L P, Primshak R A. Intravenous or enteral loop diuretics for preterm infants with (or developing) chronic lung disease.  Cochrane Database Syst Rev. 2000;  (4) CD001453
    PubMedGoogle Scholar
  • 5 Engelhardt B, Blalock W A, DonLevy S, Rush M, Hazinski T A. Effect of spironolactone-hydrochlorothiazide on lung function in infants with chronic bronchopulmonary dysplasia.  J Pediatr. 1989;  114(4 Pt 1) 619-624
    PubMedGoogle Scholar
  • 6 Levin E R, Gardner D G, Samson W K. Natriuretic peptides.  N Engl J Med. 1998;  339 321-328
    CrossrefPubMedGoogle Scholar
  • 7 Karl J, Borgya A, Gullusser A et al.. Development of a novel, N-terminal-pro BNP (NT-pro BNP) assay with a low detection limit.  Scand J Clin Lab Invest. 1999;  59(Suppl 230) 177-181
    CrossrefPubMedGoogle Scholar
  • 8 Gotze J P, Kastrup J. Plasma pro-brain natriuretic peptides are strong biochemical markers in clinical cardiology.  Scand J Clin Lab Invest. 2001;  61(Suppl 234) 47-51
    PubMedGoogle Scholar
  • 9 Mitaka C, Hirata Y, Nagura T, Tsunoda Y, Itoh M, Amaha K. Increased plasma concentrations of brain natriuretic peptide in patients with acute lung injury.  J Crit Care. 1997;  12 66-71
    CrossrefPubMedGoogle Scholar
  • 10 Maeder M, Ammann P, Rickli H, Diethelm M. Elevation of B-type natriuretic peptide levels in acute respiratory distress syndrome.  Swiss Med Wkly. 2003;  133 515-518
    PubMedGoogle Scholar
  • 11 Nir A, Bar-Oz B, Perles Z, Brooks R, Korach A, Rein A J. N-terminal pro-B-type natriuretic peptide: reference plasma levels from birth to adolescence. Elevated levels at birth and in infants and children with heart diseases.  Acta Paediatr. 2004;  93 603-607
    CrossrefPubMedGoogle Scholar
  • 12 Maher K O, Reed H, Cuadrado A et al.. B-type natriuretic peptide in the emergency diagnosis of critical heart disease in children.  Pediatrics. 2008;  121 e1484-e1488
    CrossrefPubMedGoogle Scholar
  • 13 Puddy V F, Amirmansour C, Williams A F, Singer D R. Plasma brain natriuretic peptide as a predictor of haemodynamically significant patent ductus arteriosus in preterm infants.  Clin Sci (Lond). 2002;  103 75-77
    CrossrefPubMedGoogle Scholar
  • 14 Reynolds E W, Ellington J G, Vranicar M, Bada H S. Brain-type natriuretic peptide in the diagnosis and management of persistent pulmonary hypertension of the newborn.  Pediatrics. 2004;  114 1297-1304
    CrossrefPubMedGoogle Scholar
  • 15 Madan A, Brozansky B S, Cole C H, Oden N L, Cohen G, Phelps D L. A pulmonary score for assessing the severity of neonatal chronic lung disease.  Pediatrics. 2005;  115 450-457
    CrossrefPubMedGoogle Scholar
  • 16 Waugh J B, Granger W M. An evaluation of 2 new devices for nasal high-flow gas therapy.  Respir Care. 2004;  49 902-906
    PubMedGoogle Scholar
  • 17 da Graca R L, Hassinger D C, Flynn P A, Sison C P, Nesin M, Auld P A. Longitudinal changes of brain-type natriuretic peptide in preterm neonates.  Pediatrics. 2006;  117 2183-2189
    CrossrefPubMedGoogle Scholar
  • 18 Nir A, Lindinger A, Rauh M et al.. NT-pro-B-type natriuretic peptide in infants and children: reference values based on combined data from four studies.  Pediatr Cardiol. 2009;  30 3-8
    CrossrefPubMedGoogle Scholar
  • 19 Czernik C, Lemmer J, Metze B, Koehne P S, Mueller C, Obladen M. B-type natriuretic peptide to predict ductus intervention in infants <28 weeks.  Pediatr Res. 2008;  64 286-290
    CrossrefPubMedGoogle Scholar
  • 20 Choi B M, Leev K H, Eun B L et al.. Utility of rapid B-type natriuteric peptide assay for diagnosis of symptomatic patent ductus arteriosus in preterm infants.  Pediatrics. 2005;  115 e255-e261
    CrossrefPubMedGoogle Scholar
  • 21 El-Khuffash A F, Amoruso M, Culliton M, Molloy E J. N-terminal pro-B-type natriuretic peptide as a marker of ductal haemodynamic significance in preterm infants: a prospective observational study.  Arch Dis Child Fetal Neonatal Ed. 2007;  92 F421-F422
    PubMedGoogle Scholar
  • 22 El-Khuffash A, Davis P G, Walsh K, Molloy E J. Cardiac troponin T and N-terminal-pro-B type natriuretic peptide reflect myocardial function in preterm infants.  J Perinatol. 2008;  28 482-486
    CrossrefPubMedGoogle Scholar
  • 23 Mourani P M, Sontag M K, Younoszai A, Ivy D D, Abman S H. Clinical utility of echocardiography for the diagnosis and management of pulmonary vascular disease in young children with chronic lung disease.  Pediatrics. 2008;  121 317-325
    CrossrefPubMedGoogle Scholar
  • 24 Horn S D, Smout R J. Effect of prematurity on respiratory syncytial virus hospital resource use and outcomes.  J Pediatr. 2003;  143(5 Suppl) S133-S141
    PubMedGoogle Scholar
  • 25 Cohen S, Springer C, Avital A et al.. Amino-terminal pro-brain-type natriuretic peptide: heart or lung disease in pediatric respiratory distress?.  Pediatrics. 2005;  115 1347-1350
    CrossrefPubMedGoogle Scholar

Elie PicardM.D. 

Department of Pediatric Pulmonology, Shaare Zedek Medical Center

POB 3235, Jerusalem 91031, Israel

Email: picard@szmc.org.il