Background and amis Optimal management of a patent ductus arteriosus (PDA) is important for improving the clinical outcomes of extremely low birth weight (ELBW) infants. Although it is reported that prophylactic cyclooxygenase inhibitors result in favorable immediate outcomes, not only serious side effect such as nephrotoxicity but also unnecessarily drug exposure without benefit are inevitable. To investigate the predictability of B-type natriuretic peptide (BNP) for early targeted treatment of hemodynamically significant PDA (hsPDA) in ELBW infants.

Methods 73 ELBW infants that underwent echocardiographic evaluation and plasma BNP measurement after birth were enrolled. 31 infants developed hsPDA (HsPDA group) and 42 infants didn’t develop hsPDA (nPDA group).

Results BNP levels of HsPDA group were significantly higher than those of nPDA group at 24 hours of age (921[318–2133] vs. 152[91–450], pg/mL) but not different at 12 hours of age. BNP levels at 24 hours of age were significantly correlated with the magnitudes of the ductal shunt but not significant at 12 hours of age. The area under the receiver operator characteristic curve of BNP levels for prediction of hsPDA at 12 and 24 hours of age was 0.584 and 0.830, respectively. At the cutoff BNP level of 200 pg/mL and 900 pg/mL at 24 hours of age, the sensitivity was 83.9% and 54.8% and the specificity was 61.9% and 95.2%, respectively.

Conclusions BNP levels at 24 hours of age can be used as a guide for early targeted treatment of hsPDA and avoid the unnecessary use of cyclooxygenase inhibitors in ELBW infants.