Can B-type natriuretic peptide be used diagnostically for patent ductus arteriosus in extremely preterm infants?

BackgroundB-type natriuretic peptide (BNP) can help define the hemodynamic significance of patent ductus arteriosus (PDA). The aim of this study was to examine if BNP can be used independently to discriminate between large and small PDAs even in extremely premature humans of less than 25 weeks of gestational age.MethodsThis was a retrospective observational study of 102 infants with a gestational age (GA) <30 weeks and more specifically of 42 infants with GA <25 weeks. BNP measurement and echocardiograms performed within 72 hours of each other were reviewed. Receiver operating characteristic curves were generated to assess diagnostic significance and optimal use thresholds.ResultsInfants with moderate to large PDAs (n = 79) had significantly higher BNP levels compared to infants with small or closed PDAs (n = 25) (median [IQ range]): 550 (277-1106) pg/mL versus 62 (33-164) pg/mL, p < 0.001). The optimal threshold for the recognition of moderate and large PDAs was 201 pg/mL (sensitivity 86%, specificity 87%, AUC: 0.89, p < 0.001) for infants <30 weeks GA and 188 pg/mL (sensitivity 88%, specificity 87%, AUC: 0.93, p < 0.001) for infants <25 weeks GA.ConclusionsBNP is an accurate PDA diagnostic tool for extremely preterm infants of less than 25 weeks in GA. Clinicians may consider BNP in preliminary determination of the significance of PDA and in settings with limited echocardiogram capabilities.