ABSTRACT
Objective To provide basis for early selection of drug intervention or surgical treatment for premature patent ductus arteriosus(PDA) by a dynamic monitoring of serum N-terminal pro-brain natri-uretic peptide(NT-proBNP)levels with ultrasonic examination,so as to improve the prognosis of premature infants. Methods A total of 108 premature infants with gestational age less than 32 weeks and body weight less than 1. 5 kg,within 24 h of birth were admitted to the Department of NICU,Harbin Children′s Hospital from June 2016 to December 2018. The serum NT-proBNP levels were measured at 3 d,6 d,9 d after birth, and echocardiography was performed at the same time. According to the results of echocardiography and clin-ical symptoms,infants were divided into haemodynamically significant PDA(hsPDA)(n＝29),asymptomatic PDA(asPDA)(n＝24)and non-PDA as control group(n＝55). Among them,the hsPDA group was further divided into drug treatment group(n＝21) and surgical treatment group(n＝8). The surgical treatment group was those who failed 2 courses of oral ibuprofen treatment or had contraindications to drug treatment. Arterial catheter ligation was used for surgical treatment group on 9 to 21 days after birth. NT-proBNP levels were de-tected at 24 hours and 3 days after surgery,and echocardiography was performed at the same time. The levels of serum NT-proBNP were compared between the three groups and before and after the treatment,and the ROC curve of NT-proBNP was drawn to analyze its diagnostic value. Results (1) At 3 and 6 days after birth,serum NT-proBNP levels were 8 346 pg/ml and 3 340 pg/ml in the hsPDA group,and 2 536 pg/ml and 1 079 pg/ml in the asPDA group,1 132 pg/ml and 879 pg/ml in the control group,respectively. The levels of NT-proBNP in the hsPDA group were significantly higher than those in the asPDA group(P<0. 05),and the levels of NT-proBNP in the asPDA group were higher than those in the control group(P<0. 05). At 9 days after birth,serum NT-proBNP levels were 2 231 pg/ml in the hsPDA group,834 pg/ml in the asPDA group, and 808 pg/ml in the control group. The levels of serum NT-proBNP in the hsPDA group were significantly higher than those in the asPDA group and the control group (P<0. 05). There was no significant difference between the asPDA group and the control group (P>0. 05). (2)At 3,6,and 9 d after birth,serum NT-proBNP levels were 9 000 pg/ml,8 989 pg/ml,9 000 pg/ml in the surgical treatment group, and 3 741 pg/ml, 2 544 pg/ml and 1 032 pg/ml in the drug treatment group,respectively. The levels of serum NT-proBNP in the surgical treatment group were significantly higher than those in the drug treatment group (P<0. 05). The serum NT-proBNP levels in both drug treatment group and surgical treatment group were significantly lower than those before treatment ( P < 0. 05 ). At 3 d after the operation, the serum NT-proBNP level was 941 pg/ml in the surgical treatment group and 736 pg/ml in the drug treatment group. There was no signifi-cant difference between the two groups (P>0. 05). (3)At 3 d after birth,the area under the ROC curve of serum NT-proBNP was 0. 91 (95%CI 0. 865-0. 964),and the sensitivity and specificity of NT-proBNP to diagnose hsPDA at 2 343. 5 pg/ml were 93. 1% and 73. 41.% respectively. Conclusion NT-proBNP level monitoring can be used as a sensitive indicator for early identification of hsPDA,and it has a clinical signifi-cance for intervention strategy and intervention time selection.
ABSTRACT
Objective@#To provide basis for early selection of drug intervention or surgical treatment for premature patent ductus arteriosus(PDA) by a dynamic monitoring of serum N-terminal pro-brain natriuretic peptide(NT-proBNP)levels with ultrasonic examination, so as to improve the prognosis of premature infants.@*Methods@#A total of 108 premature infants with gestational age less than 32 weeks and body weight less than 1.5 kg, within 24 h of birth were admitted to the Department of NICU, Harbin Children′s Hospital from June 2016 to December 2018.The serum NT-proBNP levels were measured at 3 d, 6 d, 9 d after birth, and echocardiography was performed at the same time.According to the results of echocardiography and clinical symptoms, infants were divided into haemodynamically significant PDA(hsPDA)(n=29), asymptomatic PDA(asPDA)(n=24)and non-PDA as control group(n=55). Among them, the hsPDA group was further divided into drug treatment group(n=21) and surgical treatment group(n=8). The surgical treatment group was those who failed 2 courses of oral ibuprofen treatment or had contraindications to drug treatment.Arterial catheter ligation was used for surgical treatment group on 9 to 21 days after birth.NT-proBNP levels were detected at 24 hours and 3 days after surgery, and echocardiography was performed at the same time.The levels of serum NT-proBNP were compared between the three groups and before and after the treatment, and the ROC curve of NT-proBNP was drawn to analyze its diagnostic value.@*Results@#(1) At 3 and 6 days after birth, serum NT-proBNP levels were 8 346 pg/ml and 3 340 pg/ml in the hsPDA group, and 2 536 pg/ml and 1 079 pg/ml in the asPDA group, 1 132 pg/ml and 879 pg/ml in the control group, respectively.The levels of NT-proBNP in the hsPDA group were significantly higher than those in the asPDA group(P<0.05), and the levels of NT-proBNP in the asPDA group were higher than those in the control group(P<0.05). At 9 days after birth, serum NT-proBNP levels were 2 231 pg/ml in the hsPDA group, 834 pg/ml in the asPDA group, and 808 pg/ml in the control group.The levels of serum NT-proBNP in the hsPDA group were significantly higher than those in the asPDA group and the control group (P<0.05). There was no significant difference between the asPDA group and the control group (P>0.05). (2)At 3, 6, and 9 d after birth, serum NT-proBNP levels were 9 000 pg/ml, 8 989 pg/ml, 9 000 pg/ml in the surgical treatment group, and 3 741 pg/ml, 2 544 pg/ml and 1 032 pg/ml in the drug treatment group, respectively.The levels of serum NT-proBNP in the surgical treatment group were significantly higher than those in the drug treatment group (P<0.05). The serum NT-proBNP levels in both drug treatment group and surgical treatment group were significantly lower than those before treatment (P<0.05). At 3 d after the operation, the serum NT-proBNP level was 941 pg/ml in the surgical treatment group and 736 pg/ml in the drug treatment group.There was no significant difference between the two groups (P>0.05). (3)At 3 d after birth, the area under the ROC curve of serum NT-proBNP was 0.91 (95%CI 0.865-0.964), and the sensitivity and specificity of NT-proBNP to diagnose hsPDA at 2 343.5 pg/ml were 93.1% and 73.41.% respectively.@*Conclusion@#NT-proBNP level monitoring can be used as a sensitive indicator for early identification of hsPDA, and it has a clinical significance for intervention strategy and intervention time selection.