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N-TERMINAL PROHORMONE OF BRAIN NATRIURETIC PEPTIDE IN THE DIAGNOSIS AND MANAGEMENT OF PERSISTENT PULMONARY HYPERTENSION IN NEWBORNS

Year 2022, Volume: 85 Issue: 2, 228 - 235, 24.03.2022
https://doi.org/10.26650/IUITFD.957968

Abstract

Objective: This study aimed to investigate the levels and utility of amino/N-terminal prohormone of brain natriuretic peptide (NT-proBNP) in the diagnosis of neonatal persistent pulmonary hypertension (PPHT). Materials and Methods: Infants born at ≥34 weeks of gestation were included in this retrospective cross-sectional study. In total, 33 newborns diagnosed with PPHT were included in the patient group and 50 healthy newborns were included in the control group. Patient and control groups were compared in terms of plasma NT-proBNP levels measured in the umbilical cord (UC) and at 72 hours of life. Results: The NT-proBNP levels in UC and at 72 hours were significantly higher in neonates with PPHT compared to controls (p<0.01). For the diagnosis of PPHT, UC NT-proBNP cut-off value was >2760.5 pg/ml, sensitivity was 90.7%, and specificity was 96.6% (p<0.01). For NT-proBNP at 72 hours, the cut-off value was >1414 pg/ml, sensitivity was 95.9%, and specificity was 91.2% (p<0.01). The mean UC NT-proBNP levels were 1094.7±603 pg/ml and mean NT-proBNP levels at 72 hours were 875.7±423 pg/ml in the control group. Conclusion: NT-proBNP levels are high during the initial days of life. They are useful in the diagnosis and follow-up of PPHT in newborns with hypoxemic respiratory failure and high fraction of inspired oxygen (FiO2) requirement, especially in cases where transthoracic echocardiography (TTE) cannot be performed.

References

  • 1. Steurer MA, Jelliffe-Pawlowski LL, Baer RJ, Partridge JC, Rogers EE, Keller RL. Persistent pulmonary hypertension of the newborn in late preterm and term infants in California. Pediatrics 2017;139(1):1-15. [CrossRef]
  • 2. Bendapudi P, Rao GG, Greenough A. Diagnosis and management of persistent pulmonary hypertension of the newborn. Paediatr Respir Rev 2015;16(3):157-61. [CrossRef]
  • 3. Ruoss JL, Rios DR, Levy PT. Updates on Management for Acute and Chronic Phenotypes of Neonatal Pulmonary Hypertension. Clin Perinatol 2020;47(3):593-615. [CrossRef]
  • 4. Bah MNM, Tan RYH, Razak H, Sapian MH, Abdullah N, Alias EY. Survival and associated risk factors for mortality among infants with persistent pulmonary hypertension of the newborn in Malaysia. J Perinatol 2021;41(4):786-93. [CrossRef]
  • 5. Aleem S, Robbins C, Murphy B, Elliott S, Akinyemi C, Paredes N, et al. The use of supplemental hydrocortisone in the management of persistent pulmonary hypertension of the newborn. J Perinatol 2021;41(4):794-800. [CrossRef]
  • 6. Vakrilova L. Pulmonary hypertension of the newborn mechanisms of failed circulatory adaptation afterbirth, clinical presentation and diagnosis. Akush Ginekol 2014;53(3):34-40.
  • 7. Vijlbrief DC, Benders MJ, Kemperman H, van Bel F, de Vries WB. B-Type natriuretic peptide and rebound during treatment for persistent pulmonary hypertension. J Pediatr 2012;160(1):111-5. [CrossRef]
  • 8. Fu L, Zhang X. Correlation between changes in brain natriuretic peptide and echocardiographic features in persistent pulmonary hypertension of newborn. J Matern Fetal Neonatal Med 2020;33(13):2176-80. [CrossRef]
  • 9. Jain A, McNamara PJ. Persistent pulmonary hypertension of the newborn: Advances in diagnosis and treatment. Semin Fetal Neonatal Med 2015;20(4):262-71. [CrossRef]
  • 10. Khuffash AE, Molloy E. The use of N-Terminal-Pro-BNP in preterm infants. Int J Pediatr 2009;2009:175216. [CrossRef]
  • 11. Massimiliano C. B-Type cardiac natriuretic peptides in the neonatal and pediatric intensive care units. J Pediatr Intensive Care 2016;5(4):189-97. [CrossRef]
  • 12. Bae JY, Cha HH, Seong WJ. Amino-terminal proB-type natriuretic peptide levels in the umbilical cord blood of neonates differ according to the type of prenatally diagnosed congenital heart disease. Pediatr Cardiol 2015;36(8):1742-7. [CrossRef]
  • 13. Gonzalez MR, Fernandez IB, Martinez AC, Lechuga-Sancho AML, Lopez SPL. NT-proBNP plasma levels as biomarkers for pulmonary hypertension in healthy infants with respiratory syncytial virus infection. Biomark Med 2019;13(8):605-18. [CrossRef]
  • 14. Rusmawati A, Haksari EL, Naning R. Downes score as a clinical assessment for hypoxemia in neonates with respiratory distress. Paediatrica Indonesiana 2008;48(6):342- 5. [CrossRef]
  • 15. Keller RL, Tacy TA, Hendricks-Munoz K, Xu J, Moon-Grady AJ, Neuhaus J, et al. Congenital diaphragmatic hernia: endothelin-1, pulmonary hypertension, and disease severity. Am J Respir Crit Care Med 2010;182(4):555-61. [CrossRef]
  • 16. Sovtic GM, Kosutic J, Jankovic B, Bojanin D, Sovtic A, Radojicic Z, et al. N-terminal pro-brain natriuretic peptide in the assessment of respiratory distress in term neonates. Pediatr Int 2014;56(3):373-7. [CrossRef]
  • 17. Dasgupta S, Bettermann E, Kelleman M, Kanaan U, Sachdeva R, Petit C, et al. N-terminal pro-B-type-natriuretic peptide as a screening tool for pulmonary hypertension in the paediatric population. Cardiol Young 2021;31(10):1595- 607. [CrossRef]
  • 18. Zhu R, Nie Z. A clinical study of the N-terminal pro-brain natriuretic peptide in myocardial injury after neonatal asphyxia. Pediatr Neonatol 2016;57(2):133-9. [CrossRef]
  • 19. Schwachtgen L, Herrmann M, Georg T, Schwarz P, Marx N, Lindinger A. Reference values of NT-proBNP serum concentrations in the umbilical cord blood and in healthy neonates and children. Z Kardiol 2005;94(6):399-404. [CrossRef]
  • 20. Steurer MA, Baer RJ, Oltman S, Ryckman KK, Feuer SK, Rogers E, et al. Morbidity of persistent pulmonary hypertension of the newborn in the first year of life. J Pediatr 2019;213:58-65.e4. [CrossRef]
  • 21. Bhattacharya S, Sen S, Levy PT, Rios DR. Comprehensive evaluation of right heart performance and pulmonary hemodynamics in neonatal pulmonary hypertension. Curr Treat Options Cardiovacs Med 2019;21(2):10. [CrossRef]
  • 22. Mannarino S, Garofoli F, Mongini E, Cerbo RM, Codazzi AC, Tzialla C, et al. BNP concentrations and cardiovascular adaptation in preterm and fullterm newborn infants. Early Hum Dev 2010;86(5):295-8. [CrossRef]
  • 23. Seong JW, Yoon DH, Chong GO, Hong DG, Koo TB, Lee TH, et al. Umbilical cord blood amino-terminal pro-brain natriuretic peptide levels according to the mode of delivery. Arch Gynecol Obstet 2010;281(5):907-12. [CrossRef]
  • 24. Neves AL, Henriques-Coelho T, Leite-Moreira A, Areias JC. The utility of brain natriuretic peptide in pediatric cardiology: A review. Pediatr Crit Care Med 2016;17(11):e529-38. [CrossRef]
  • 25. Koch A, Zink S, Singer H. B-type natriuretic peptide in paediatric patients with congenital heart disease. European Heart Journal 2006;27(7):861-6. [CrossRef]
  • 26. Ahmed AM, Mohamed NAEG, Abdelhamid EM, Taha RI, Abo-Hashish MMA. N-terminal pro-brain natriuretic peptide as a biomarker for differentiating cardiac and pulmonary disease in term neonates with respiratory distress. J Saudi Heart Assoc 2020;32(1):65-70. [CrossRef]
  • 27. Heindel K, Holdenrieder S, Patel N, Bartmann P, Schroeder L, Berg C, et al. Early postnatal changes of circulating N-terminal-pro-B-type natriuretic peptide in neonates with congenital diaphragmatic hernia. Early Hum Dev 2020;146:105049:1-7. [CrossRef]

YENİDOĞANLARDA PERSİSTAN PULMONER HİPERTANSİYON TANISI VE YÖNETİMİNDE N-TERMİNAL PROHORMON BRAİN NATRİÜRETİK PEPTİD

Year 2022, Volume: 85 Issue: 2, 228 - 235, 24.03.2022
https://doi.org/10.26650/IUITFD.957968

Abstract

Amaç: Bu çalışmada, beyin natriüretik peptidinin (NT-proBNP) amino/N-terminal prohormonunun duzeylerinin ve yenidoğan kalıcı pulmoner hipertansiyon (PPHT) tanısında kullanımının araştırılması amaçlandı. Gereç ve Yöntem: Bu retrospektif kesitsel çalışmaya ≥34 gebelik haftasında doğan bebekler dahil edildi. Hasta grubuna PPHT tanısı konan 33 yenidoğan, kontrol grubuna ise 50 sağlıklı yenidoğan alındı. Hasta ve kontrol grupları, göbek kordonunda (UC) ve 72 saatlik yaşamda ölçülen plazma NT-proBNP seviyeleri açısından karşılaştırıldı. Bulgular: UC’da ve 72. saatte NT-proBNP seviyeleri, kontrollere kıyasla PPHT’lu yenidoğanlarda anlamlı derecede yüksekti (p<0,01). PPHT tanısı için UC NT-proBNP eşik değeri >2760,5 pg/ml, duyarlılık %90,7 ve özgüllük %96,6 (p<0,01) idi. Yetmişikinci saatte NT-proBNP için eşik değeri >1414 pg/ml, duyarlılık %95,9 ve özgüllük %91,2 idi (p<0,01). Kontrol grubunda ortalama UC NT-proBNP seviyeleri 1094,7±603 pg/ml ve 72 saatte ortalama NT-proBNP seviyeleri 875,7±423 pg/ml idi. Sonuç: NT-proBNP seviyeleri yaşamın ilk günlerinde yüksektir. Özellikle transtorasik ekokardiyografinin (TTE) yapılamadığı durumlarda, hipoksemik solunum yetmezliği ve inspire edilen oksijen fraksiyonu (FiO2) gereksinimi yüksek olan yenidoğanlarda PPHT tanı ve takibinde faydalıdır.

References

  • 1. Steurer MA, Jelliffe-Pawlowski LL, Baer RJ, Partridge JC, Rogers EE, Keller RL. Persistent pulmonary hypertension of the newborn in late preterm and term infants in California. Pediatrics 2017;139(1):1-15. [CrossRef]
  • 2. Bendapudi P, Rao GG, Greenough A. Diagnosis and management of persistent pulmonary hypertension of the newborn. Paediatr Respir Rev 2015;16(3):157-61. [CrossRef]
  • 3. Ruoss JL, Rios DR, Levy PT. Updates on Management for Acute and Chronic Phenotypes of Neonatal Pulmonary Hypertension. Clin Perinatol 2020;47(3):593-615. [CrossRef]
  • 4. Bah MNM, Tan RYH, Razak H, Sapian MH, Abdullah N, Alias EY. Survival and associated risk factors for mortality among infants with persistent pulmonary hypertension of the newborn in Malaysia. J Perinatol 2021;41(4):786-93. [CrossRef]
  • 5. Aleem S, Robbins C, Murphy B, Elliott S, Akinyemi C, Paredes N, et al. The use of supplemental hydrocortisone in the management of persistent pulmonary hypertension of the newborn. J Perinatol 2021;41(4):794-800. [CrossRef]
  • 6. Vakrilova L. Pulmonary hypertension of the newborn mechanisms of failed circulatory adaptation afterbirth, clinical presentation and diagnosis. Akush Ginekol 2014;53(3):34-40.
  • 7. Vijlbrief DC, Benders MJ, Kemperman H, van Bel F, de Vries WB. B-Type natriuretic peptide and rebound during treatment for persistent pulmonary hypertension. J Pediatr 2012;160(1):111-5. [CrossRef]
  • 8. Fu L, Zhang X. Correlation between changes in brain natriuretic peptide and echocardiographic features in persistent pulmonary hypertension of newborn. J Matern Fetal Neonatal Med 2020;33(13):2176-80. [CrossRef]
  • 9. Jain A, McNamara PJ. Persistent pulmonary hypertension of the newborn: Advances in diagnosis and treatment. Semin Fetal Neonatal Med 2015;20(4):262-71. [CrossRef]
  • 10. Khuffash AE, Molloy E. The use of N-Terminal-Pro-BNP in preterm infants. Int J Pediatr 2009;2009:175216. [CrossRef]
  • 11. Massimiliano C. B-Type cardiac natriuretic peptides in the neonatal and pediatric intensive care units. J Pediatr Intensive Care 2016;5(4):189-97. [CrossRef]
  • 12. Bae JY, Cha HH, Seong WJ. Amino-terminal proB-type natriuretic peptide levels in the umbilical cord blood of neonates differ according to the type of prenatally diagnosed congenital heart disease. Pediatr Cardiol 2015;36(8):1742-7. [CrossRef]
  • 13. Gonzalez MR, Fernandez IB, Martinez AC, Lechuga-Sancho AML, Lopez SPL. NT-proBNP plasma levels as biomarkers for pulmonary hypertension in healthy infants with respiratory syncytial virus infection. Biomark Med 2019;13(8):605-18. [CrossRef]
  • 14. Rusmawati A, Haksari EL, Naning R. Downes score as a clinical assessment for hypoxemia in neonates with respiratory distress. Paediatrica Indonesiana 2008;48(6):342- 5. [CrossRef]
  • 15. Keller RL, Tacy TA, Hendricks-Munoz K, Xu J, Moon-Grady AJ, Neuhaus J, et al. Congenital diaphragmatic hernia: endothelin-1, pulmonary hypertension, and disease severity. Am J Respir Crit Care Med 2010;182(4):555-61. [CrossRef]
  • 16. Sovtic GM, Kosutic J, Jankovic B, Bojanin D, Sovtic A, Radojicic Z, et al. N-terminal pro-brain natriuretic peptide in the assessment of respiratory distress in term neonates. Pediatr Int 2014;56(3):373-7. [CrossRef]
  • 17. Dasgupta S, Bettermann E, Kelleman M, Kanaan U, Sachdeva R, Petit C, et al. N-terminal pro-B-type-natriuretic peptide as a screening tool for pulmonary hypertension in the paediatric population. Cardiol Young 2021;31(10):1595- 607. [CrossRef]
  • 18. Zhu R, Nie Z. A clinical study of the N-terminal pro-brain natriuretic peptide in myocardial injury after neonatal asphyxia. Pediatr Neonatol 2016;57(2):133-9. [CrossRef]
  • 19. Schwachtgen L, Herrmann M, Georg T, Schwarz P, Marx N, Lindinger A. Reference values of NT-proBNP serum concentrations in the umbilical cord blood and in healthy neonates and children. Z Kardiol 2005;94(6):399-404. [CrossRef]
  • 20. Steurer MA, Baer RJ, Oltman S, Ryckman KK, Feuer SK, Rogers E, et al. Morbidity of persistent pulmonary hypertension of the newborn in the first year of life. J Pediatr 2019;213:58-65.e4. [CrossRef]
  • 21. Bhattacharya S, Sen S, Levy PT, Rios DR. Comprehensive evaluation of right heart performance and pulmonary hemodynamics in neonatal pulmonary hypertension. Curr Treat Options Cardiovacs Med 2019;21(2):10. [CrossRef]
  • 22. Mannarino S, Garofoli F, Mongini E, Cerbo RM, Codazzi AC, Tzialla C, et al. BNP concentrations and cardiovascular adaptation in preterm and fullterm newborn infants. Early Hum Dev 2010;86(5):295-8. [CrossRef]
  • 23. Seong JW, Yoon DH, Chong GO, Hong DG, Koo TB, Lee TH, et al. Umbilical cord blood amino-terminal pro-brain natriuretic peptide levels according to the mode of delivery. Arch Gynecol Obstet 2010;281(5):907-12. [CrossRef]
  • 24. Neves AL, Henriques-Coelho T, Leite-Moreira A, Areias JC. The utility of brain natriuretic peptide in pediatric cardiology: A review. Pediatr Crit Care Med 2016;17(11):e529-38. [CrossRef]
  • 25. Koch A, Zink S, Singer H. B-type natriuretic peptide in paediatric patients with congenital heart disease. European Heart Journal 2006;27(7):861-6. [CrossRef]
  • 26. Ahmed AM, Mohamed NAEG, Abdelhamid EM, Taha RI, Abo-Hashish MMA. N-terminal pro-brain natriuretic peptide as a biomarker for differentiating cardiac and pulmonary disease in term neonates with respiratory distress. J Saudi Heart Assoc 2020;32(1):65-70. [CrossRef]
  • 27. Heindel K, Holdenrieder S, Patel N, Bartmann P, Schroeder L, Berg C, et al. Early postnatal changes of circulating N-terminal-pro-B-type natriuretic peptide in neonates with congenital diaphragmatic hernia. Early Hum Dev 2020;146:105049:1-7. [CrossRef]
There are 27 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section RESEARCH
Authors

Sinan Tüfekci 0000-0003-0367-3828

Ozgur Kızılca 0000-0003-1587-7051

Erhan Aygün 0000-0002-4495-5824

Publication Date March 24, 2022
Submission Date June 26, 2021
Published in Issue Year 2022 Volume: 85 Issue: 2

Cite

APA Tüfekci, S., Kızılca, O., & Aygün, E. (2022). N-TERMINAL PROHORMONE OF BRAIN NATRIURETIC PEPTIDE IN THE DIAGNOSIS AND MANAGEMENT OF PERSISTENT PULMONARY HYPERTENSION IN NEWBORNS. Journal of Istanbul Faculty of Medicine, 85(2), 228-235. https://doi.org/10.26650/IUITFD.957968
AMA Tüfekci S, Kızılca O, Aygün E. N-TERMINAL PROHORMONE OF BRAIN NATRIURETIC PEPTIDE IN THE DIAGNOSIS AND MANAGEMENT OF PERSISTENT PULMONARY HYPERTENSION IN NEWBORNS. İst Tıp Fak Derg. March 2022;85(2):228-235. doi:10.26650/IUITFD.957968
Chicago Tüfekci, Sinan, Ozgur Kızılca, and Erhan Aygün. “N-TERMINAL PROHORMONE OF BRAIN NATRIURETIC PEPTIDE IN THE DIAGNOSIS AND MANAGEMENT OF PERSISTENT PULMONARY HYPERTENSION IN NEWBORNS”. Journal of Istanbul Faculty of Medicine 85, no. 2 (March 2022): 228-35. https://doi.org/10.26650/IUITFD.957968.
EndNote Tüfekci S, Kızılca O, Aygün E (March 1, 2022) N-TERMINAL PROHORMONE OF BRAIN NATRIURETIC PEPTIDE IN THE DIAGNOSIS AND MANAGEMENT OF PERSISTENT PULMONARY HYPERTENSION IN NEWBORNS. Journal of Istanbul Faculty of Medicine 85 2 228–235.
IEEE S. Tüfekci, O. Kızılca, and E. Aygün, “N-TERMINAL PROHORMONE OF BRAIN NATRIURETIC PEPTIDE IN THE DIAGNOSIS AND MANAGEMENT OF PERSISTENT PULMONARY HYPERTENSION IN NEWBORNS”, İst Tıp Fak Derg, vol. 85, no. 2, pp. 228–235, 2022, doi: 10.26650/IUITFD.957968.
ISNAD Tüfekci, Sinan et al. “N-TERMINAL PROHORMONE OF BRAIN NATRIURETIC PEPTIDE IN THE DIAGNOSIS AND MANAGEMENT OF PERSISTENT PULMONARY HYPERTENSION IN NEWBORNS”. Journal of Istanbul Faculty of Medicine 85/2 (March 2022), 228-235. https://doi.org/10.26650/IUITFD.957968.
JAMA Tüfekci S, Kızılca O, Aygün E. N-TERMINAL PROHORMONE OF BRAIN NATRIURETIC PEPTIDE IN THE DIAGNOSIS AND MANAGEMENT OF PERSISTENT PULMONARY HYPERTENSION IN NEWBORNS. İst Tıp Fak Derg. 2022;85:228–235.
MLA Tüfekci, Sinan et al. “N-TERMINAL PROHORMONE OF BRAIN NATRIURETIC PEPTIDE IN THE DIAGNOSIS AND MANAGEMENT OF PERSISTENT PULMONARY HYPERTENSION IN NEWBORNS”. Journal of Istanbul Faculty of Medicine, vol. 85, no. 2, 2022, pp. 228-35, doi:10.26650/IUITFD.957968.
Vancouver Tüfekci S, Kızılca O, Aygün E. N-TERMINAL PROHORMONE OF BRAIN NATRIURETIC PEPTIDE IN THE DIAGNOSIS AND MANAGEMENT OF PERSISTENT PULMONARY HYPERTENSION IN NEWBORNS. İst Tıp Fak Derg. 2022;85(2):228-35.

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