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Updated: Jun 27, 2026
Hemodynamic Precision in the Neonatal Intensive Care Unit using Targeted Neonatal Echocardiography
Published on: January 27, 2023
N-terminal probrain natriuretic peptide and patent ductus arteriosus in preterm infants
P Nuntnarumit1, A Khositseth, P Thanomsingh
1Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. tepnt@mahidol.ac.th
Objective:
To determine whether plasma N-terminal probrain natriuretic peptide (NT-proBNP) in premature infants could identify hemodynamically significant patent ductus arteriosus (HsPDA) and to determine the correlation between serial plasma NT-proBNP and echocardiographic assessment of ductal shunting.
Study Design:
An observational study involving 35 preterm infants who underwent echocardiographic assessment for PDA on day 2, 4 and 7 of life with simultaneous blood sampling for determination of NT-proBNP concentrations. HsPDA was diagnosed by left-to-right ductal shunt on color Doppler, measuring diameter >1.5 mm on two-dimensional echocardiography plus > or =2 clinical features of PDA.
Result:
Plasma NT-proNBP levels on day 2 in the HsPDA group (n=12) were significantly higher than in non-HsPDA group (n=23) with a median of 16,353 pg ml(-1) (interquartile range (IQR), 12,360-33,459; range, 10,316-104,998) vs 3914 pg ml(-1) (IQR, 2601-5782; range, 1535-19,516) (P<0.001), respectively. Eight infants (67%) in the HsPDA group responded to an initial course of indomethacin or ibuprofen and their NT-proBNP levels significantly decreased within 48 h after treatment compared with non-responders (P=0.007). NT-proBNP concentrations were significantly correlated with left atrial to aortic root ratio. A cut-off NT-proBNP on day 2 of 10,180 pg ml(-1) offered the best predictive values for HsPDA with a sensitivity of 100% and a specificity of 91%.
Conclusion:
Plasma NT-proBNP on day 2 was found as a sensitive marker for predicting HsPDA in preterm infants. Successful closure of PDA was also correspondent with the decline in plasma NT-proBNP.
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