Infants in the poor outcome group had a significantly higher inhibitor Imatinib NTpBNP levels at 48 hours compared to infants without PDA-associated complications (9284pmol/L [5013�C16911] versus 5121pmol/L [2324�C6202], P = .008). The AUC for NTpBNP’s ability to predict severe IVH and/or death as a complication of a PDA is 0.84 (95% CI 0.72 �C 0.96, P �� .001). A level of 5500pmol/L has a sensitivity of 80% and a specificity of 80%. Only one infant in the Spontaneous PDA closure group died before discharge. The 12- and 48-hour NTpBNP levels were 2023pmol/L and 6605pmol/L respectively. NTpBNP may be an independent marker of poor neonatal short-term outcome irrespective of PDA presence (29). Gagliardi L et al. assessed the discriminatory ability of the clinical risk index for babies (CRIBs), CRIB-II, and SNAPPE-II in detecting death before discharge in 720 preterm infants [44].

Following the exclusion of babies weighing 400�C499g (n = 15), the AUCs for CRIB, CRIB-II, and SNAPPE-II were 0.898, 0.905, and 0.835, respectively. These results were comparable to the AUCs for NTpBNP and death in this cohort. NTpBNP may prove to be a useful adjunct to clinical and echocardiographic PDA staging system proposed by McNamara et al. [45]. Medical therapy for PDA has well recognised adverse effects and neither prophylaxis nor treatment on the basis of clinical and echocardiographic signs have been shown to improve long-term outcomes. Accurately identifying infants with PDA who are at highest risk of poor outcome using NTpBNP may allow more successful trials of targeted medical therapy of PDA. 6.

Other Applications of NTpBNP Pulmonary vascular resistance may remain elevated during the neonatal period leading to difficulties in oxygenation and resulting in pulmonary hypertension (PHT). Echocardiography is required to distinguish PHT from other respiratory and cardiac disorders by demonstrating suprasystemic pulmonary vascular pressures. In a study of 28 term infants, Baptista et al. showed a significantly higher NTpBNP level in infants with PHT secondary to congenital diaphragmatic hernia (CHD) compared to age and weight matched controls (1563 versus 591pmol/L, P < .05). There was a good correlation with right ventricular mean pressure (r = 0.45, P = .03) and RV Tei index. This measurement is a combined myocardial performance index (isovolumic contraction time plus isovolumic relaxation time divided by ejection time) (r = ?0.

46, P = .02). In addition, the prognostic properties of NTpBNP are demonstrated in this trial. Nine infants in the CHD group died before discharge. NTpBNP was higher in the nonsurvivors (2679 versus 737pmol/L, P = .009). A level of 1360pmol/L had a 100% sensitivity and 67% specificity for identifying these infants. Plasma BNP increases in animal models with induced Dacomitinib endotoxaemia and the proinflammatory cytokine inter leukin-6 (IL-6) has been linked with BNP production. Therefore, the rise of BNP may not be solely due to ventricular overloading.