Biochemical markers may identify preterm infants with a patent ductus arteriosus at high risk of death of severe intraventricular haemorrhage

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.