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Biochemical markers may identify preterm infants with a patent ductus arteriosus at high risk of death of severe intraventricular haemorrhage
  1. Afif Faisal EL-Khuffash (afif_faisal{at}hotmail.com)
  1. National Maternity Hospital, Republic of Ireland
    1. Declan Barry (deaglandebarra_99{at}yahoo.com)
    1. National Maternity Hospital, Republic of Ireland
      1. Kevin Walsh (kpwalsh{at}oceanfree.net)
      1. Our Ladys Hospital for Sick Children, Republic of Ireland
        1. Peter Graham Davis (pgd{at}unimelb.edu.au)
        1. Royal Women's Hospital, Melbourne, Australia
          1. Eleanor J Molloy (elesean{at}hotmail.com)
          1. National Maternity hospital, Republic of Ireland

            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 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 hours predict death before discharge or severe IVH in preterm infants with a PDA.

            Methods: Infants born < 32 weeks gestation or < 1500g underwent echocardiographic and cTnT/NTpBNP measurements at 12 and 48 hours of life. Infants were divided according to their status at discharge: a closed PDA at 48 hours, infants with a PDA at 48 hours and IVH III/IV and/or death, and infants with a PDA at 48 hours 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 hours, infants with a PDA and IVH III/IV and/or death had significantly higher median NTpBNP/cTnT 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, LA:Ao ratio, 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.

            • NTpBNP
            • cTnT
            • patent ductus arteriosus
            • preterm infant

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