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Arch Dis Child Fetal Neonatal Ed 2009;94:F178-F182 doi:10.1136/adc.2008.147587
  • Original article

B-type natriuretic peptide concentrations to guide treatment of patent ductus arteriosus

  1. J T Attridge1,
  2. D A Kaufman1,
  3. D S Lim2
  1. 1
    Department of Paediatrics, Division of Neonatology, University of Virginia, Charlottesville, Virginia, USA
  2. 2
    Department of Paediatrics, Division of Paediatric Cardiology, University of Virginia, Charlottesville, Virginia, USA
  1. Dr J T Attridge, Box 800386, Charlottesville, VA 22908, USA; ja5u{at}virginia.edu
  • Accepted 27 September 2008
  • Published Online First 3 November 2008

Abstract

Objective: To determine whether b-type natriuretic peptide (BNP) concentrations can guide treatment of patent ductus arteriosus (PDA) to reduce the number of indomethacin doses without increasing morbidity.

Design: Prospective, randomised, controlled trial.

Setting: Single-centre referral neonatal intensive care unit.

Patients: Infants with echocardiographic diagnosis of PDA. Infants with congenital heart disease or renal insufficiency were excluded.

Interventions: BNP measurement and echocardiography were performed in all subjects before and after indomethacin treatment. The investigational group had BNP concentrations measured 12 and 24 h after the first dose (before the 2nd and 3rd doses of indomethacin). Indomethacin dosing was withheld in the BNP-guided group if the 12 or 24 h BNP concentrations were found to be <100 pg/ml.

Main outcome measures: Number of doses of indomethacin given during the primary course of treatment (three doses every 12 h).

Results: Sixty patients were randomly assigned to control (n = 30) and BNP-guided (n = 30) treatment groups. There was no difference between the groups with respect to gestational age (26+3 vs 25+5 weeks, respectively), Apgar scores, delivery method, gender or indomethacin prophylaxis. Median baseline and 48 h BNP concentrations did not differ between the groups (0 h: 500 vs 542 pg/ml; 48 h: 85 vs 126 pg/ml; control and BNP-guided groups, respectively). During primary indomethacin treatment, the BNP-guided group received fewer doses of indomethacin than controls (70 vs 88 doses, p<0.05). The rate of PDA ligation, intestinal perforation and chronic lung disease did not differ between groups.

Conclusions: BNP-guided treatment reduced the number of primary indomethacin doses. There was no increase in PDA persistence or associated morbidity.

Footnotes

  • Funding: Funding for this study was provided from the University of Virginia Children’s Hospital Fellow Grant-in-Aid.

  • Competing interests: None.

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