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Biomarker screening for pulmonary hypertension in VLBW infants at risk for bronchopulmonary dysplasia

Fernando A Munoz1, Amanda Kim2, Brendan Kelly3

  • 1Division of Neonatology, Department of Pediatrics, Oregon Health & Science University, Portland, OR, USA. munozf@ohsu.edu.

Pediatric Research
|August 31, 2024
PubMed

Insights

Biomarkers NT-proBNP and bicarbonate can help identify very low birth weight (VLBW) infants at low risk for bronchopulmonary dysplasia-associated pulmonary hypertension (BPD-PH). This combination may help avoid unnecessary echocardiograms for VLBW infants.

Area of Science:

  • Neonatal Medicine
  • Pediatric Cardiology
  • Respiratory Medicine

Background:

  • Very low birth weight (VLBW) infants have abnormal lung development, increasing their risk for bronchopulmonary dysplasia (BPD) and pulmonary hypertension (PH).
  • Accurate risk stratification for BPD-associated PH (BPD-PH) is crucial for timely management and improved outcomes in these vulnerable infants.

Purpose of the Study:

  • To evaluate the effectiveness of NT-proBNP and bicarbonate levels in identifying VLBW infants at low risk for BPD-PH.
  • To determine if a combined biomarker approach can reduce the need for screening echocardiograms in VLBW infants.

Main Methods:

  • VLBW infants on respiratory support at 34 weeks corrected gestational age were screened using blood gas, serum NT-proBNP, and bicarbonate (HCO3) levels.
  • Eleven predictive models were tested using various cutoffs for NT-proBNP and HCO3 to identify infants at low risk for BPD-PH.

Main Results:

  • Pulmonary hypertension (PH) was detected in 17.6% of VLBW infants.
  • A model combining NT-proBNP < 950 pg/mL and HCO3 < 32 mmol/L demonstrated 100% sensitivity and 100% negative predictive value for BPD-PH.
  • This model could have identified 28% of infants as low risk, potentially avoiding echocardiography.

Conclusions:

  • Serum NT-proBNP and bicarbonate levels are sensitive and cost-effective screening tools for BPD-PH in VLBW infants.
  • The combination of NT-proBNP and HCO3 is more effective than NT-proBNP alone in identifying VLBW infants who may avoid screening echocardiography.
Abstract

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