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PRO-BRAIN-NATRIURETIC-PEPTIDE (PRO-BNP) AS A PROGNOSTIC FACTOR IN NEWBORNS WITH CONGENITAL DIAPHRAGMATIC HERNIA (CDH)
  1. T Schaible1,
  2. V Böttcher1,
  3. S Hien1,
  4. M Kratz1
  1. 1University Hospital Mannheim, Children Hospital, Baden-Württemberg, Germany

Abstract

Objective CDH is often associated with pulmonary hypertension in the newborn. Together with fetal hemodynamic situation -pathologic ductus venosus streaming- they may lead to overdistension of the right heart. In this study we wanted to find out if NT-Pro-BNP, a hormone built by cardiomyocytes during stretching, could be a prediction parameter for outcome in CDH patients.

Methods Plasma NT-Pro-BNP was measured once directly after birth in 26 newborns with CDH without cardiac anomalies and set in relation to need of Extracorporale Membrane Oxygenation (ECMO), Lung to Head Ratio (late LHR between 32 and 36 weeks of gestation), liver up or down and outcome. Standard values were measured at 10 mature and healthy newborns right after caesarean section.

Results CDH-newborns showed a higher median NT-Pro-BNP concentration than healthy newborns (p<0,004). LHR and NT-Pro-BNP were closely correlated, inversely proportional (r = −0,62; p<0,001). CDH-newborns with need of ECMO (n = 8) had no significantly higher NT-Pro-BNP than without ECMO (n = 18). There is a trend in higher NT-Pro-BNP in liver up patients (n = 6) compared with liver down (n = 20). Concerning the following outcome criteria Chronic lung disease (CLD) -need for oxygen at day 28- (12 patients), no CLD (10 patients) and exitus letalis (n = 4) we found no significant prediction.

Conclusions Plasma NT-Pro-BNP values seem to be helpful for some of our investigated topics, but further work with higher numbers of patients and more values during the clinical course are necessary to strengthen their predictive power.

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