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BIOCHEMICAL MARKERS MAY IDENTIFY PRETERM INFANTS WITH A PATENT DUCTUS ARTERIOSUS AT HIGH RISK OF DEATH OR SEVERE INTRAVENTRICULAR HAEMORRHAGE
  1. A F EL-Khuffash1,2,
  2. D Barry1,
  3. K Walsh2,
  4. P G Davis3,
  5. E J Molloy1,2
  1. 1Department of Neonatology, National Maternity Hospital, Dublin, Ireland,
  2. 2Department of Paediatric Cardiology, Our Lady’s Children Hospital, Crumlin, Ireland,
  3. 3Neonatal Services, Royal Women’s Hospital, Carlton, Australia

Abstract

Background A patent ductus arteriosus (PDA) in preterm infants is associated with an 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 h predict death before discharge or severe IVH in preterm infants with a PDA.

Methods Infants born <32 weeks gestation or <1500 g underwent echocardiographic and cTnT/NTpBNP measurements at 12 and 48 h of life. Infants were divided according to their status at discharge: a closed PDA at 48 h, infants with a PDA at 48 h and IVH III/IV and/or death and infants with a PDA at 48 h without IVH III/IV or death.

Results Eighty infants with a median gestation of 28 weeks (interquartile range 26.1–29.5) and birth weight 1.06 kg (0.8–1.21) were included. At 48 h, infants with a PDA and IVH III/IV and/or death had significantly higher median NTpBNP/cTnT levels compared with 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.

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