Background and aims In infants with congenital diaphragmatic hernia (CDH) plasma peptides which mediate, or are produced in response to PH and cardiovascular dysfunction may be useful clinical biomarkers of disease status and predictors of outcome. This prospective pilot study investigated patterns of selected candidate plasma peptides in relation to disease severity and outcome in infants with CDH.
Methods In ten consecutive infants with CDH, serial plasma samples for peptide analysis (BNP, NTproBNP, VEGF-A, PLGF) were obtained during intensive care admission at defined time points (max. 5 days apart) up to discharge or death.
Results Analysis was performed on 80 samples. Six subjects survived to discharge (median 24, range 16–52, days); there were two early deaths (at 7 and 9 days) and two late deaths (72 and 160 days). BNP, NTproBNP, and VEGF-A, were higher in non-surviving infants in the first 48 h of life (Figure 1). NTproBNP remained elevated among non-survivors throughout admission (Figure 2). Conversely, PLGF was lower in survivors in the first 48 h, and throughout admission (Figures 1 & 2).
Conclusions · Elevated BNP, NTproBNP and VEGF-A appear to be associated with poorer outcomes in CDH.
· In this first report of PLGF (placental growth factor) in CDH, levels appear to be inversely related to poorer outcomes.
· These peptides may be potential mediators and clinical biomarkers of disease course, predictors of outcome and therapeutic targets in CDH. Further investigation is warranted.
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