Diagnosing significant PDA using natriuretic peptides in preterm neonates: a systematic review

Area of Science:

• Neonatal Medicine
• Biomarker Diagnostics
• Pediatric Cardiology

Background:

• Echocardiography is the standard for diagnosing hemodynamically significant patent ductus arteriosus (hsPDA) in preterm neonates.
• Brain natriuretic peptide (BNP) and amino-terminal pro-B-type natriuretic peptide (NT-proBNP) blood assays may aid in hsPDA diagnosis and management.
• Significant variability exists in studies assessing these biomarkers, impacting generalizability.

Purpose of the Study:

• To determine the diagnostic accuracy of BNP and NT-proBNP for hsPDA in preterm neonates.
• To explore heterogeneity in diagnostic accuracy across different subgroups.
• To provide evidence-based recommendations for the clinical use of these biomarkers.

Main Methods:

• Systematic review adhering to Cochrane Diagnostic Test Accuracy guidelines.
• Inclusion of studies comparing BNP or NT-proBNP (index tests) against echocardiography (reference standard) in preterm neonates with suspected hsPDA.
• Bivariate random effects model meta-analysis with summary receiver operating characteristic (SROC) curve generation.

Main Results:

• Ten studies evaluated BNP and 11 evaluated NT-proBNP.
• Summary sensitivity and specificity for BNP were 88% and 92%, respectively.
• Summary sensitivity and specificity for NT-proBNP were 90% and 84%, respectively.

Conclusions:

• Diagnostic accuracy of BNP and NT-proBNP assays for hsPDA varies due to differences in assay kits, thresholds, and patient characteristics.
• Generalizability of current findings across different clinical centers is limited.
• Local validation of BNP or NT-proBNP assays is recommended for specific patient populations and clinical outcomes.