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Biochemical markers may identify preterm infants with a patent ductus arteriosus at high risk of death or severe intraventricular haemorrhage
  1. A El-Khuffash1,
  2. D Barry1,
  3. K Walsh2,
  4. P G Davis3,
  5. E J Molloy1,2
  1. 1
    Department of Neonatology, National Maternity Hospital, Dublin, Ireland
  2. 2
    Department of Paediatric Cardiology, Our Lady’s Children Hospital, Crumlin, Ireland
  3. 3
    Neonatal Services, Royal Women’s Hospital, Carlton, Victoria, Australia
  1. Afif El-Khuffash, National Maternity Hospital, Holles Street, Dublin 2, Ireland; afif_faisal{at}hotmail.com

Abstract

Background: A patent ductus arteriosus (PDA) in preterm infants is associated with increased risk of intraventricular haemorrhage (IVH) and death. Cardiac troponin T (cTnT) and N-terminal-pro-B type natriuretic peptide (NTpBNP) are markers of cardiac function and can predict poor outcome in adults.

Aims: To determine whether echocardiography and cTnT/NTpBNP levels at 48 h predict death before discharge or severe IVH in preterm infants with a PDA.

Methods: Infants born <32 weeks' gestation or <1500 g underwent echocardiographic and cTnT/NTpBNP measurements at 12 and 48 h of life. Infants were divided according to their status at discharge: a closed PDA at 48 h, infants with a PDA at 48 h and IVH III/IV and/or death, and infants with a PDA at 48 h without IVH III/IV or death.

Results: Eighty infants with a median gestation of 28 weeks (IQR 26.1–29.5) and birth weight 1.06 kg (0.8–1.21) were included. At 48 h, infants with a PDA and IVH III/IV and/or death had significantly higher median cTnT/NTpBNP levels compared to infants with a PDA without IVH III/IV and/or death and those with spontaneous PDA closure (NTpBNP 9282, 5121 and 740 pmol/l, respectively, p = 0.008, and cTnT 0.66, 0.25 and 0.13 µg/l, respectively, p = 0.027). There were no differences in echocardiographic parameters of PDA size, left atrial to aortic ratio (LA:Ao), left and right ventricular outputs between the PDA groups.

Conclusions: NTpBNP and cTnT in conjunction with echocardiography may provide a basis for trials of targeted medical treatment in infants with a PDA.

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Footnotes

  • Competing interests: None.

  • Funding: National Maternity Hospital Research Fund.

  • Ethics approval: The study was approved prior to commencement by the National Maternity Hospital’s Ethics Committee, Dublin, Ireland.

  • Patient consent: Informed parental consent was requested within the first 24 h of life.

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