THE EFFECT OF DELIVERY MODE ON NT-PROBNP LEVELS IN NEWBORNS

Year 2023, Volume: 25 Issue: 1, 48 - 55, 30.04.2023

İlknur Kaba , Didem Aliefendioğlu

https://doi.org/10.24938/kutfd.1142172

Abstract

Objective: Reference values of NT-proBNP levels in newborns may vary depending on gestational age, postnatal age and Apgar scores. However, the effect of the mode of delivery has been less investigated, and the results are contradictory. In this study, it was aimed to compare NT-proBNP levels in healthy term newborns born through vaginal delivery and cesarean (C/S) and to investigate whether delivery method had an effect on it.

Material and Methods: Healthy newborns born in our hospital and with a gestational age of ≥38 weeks were included in the study. Cases (n=56) were grouped according to delivery type. Both groups were similar in terms of gender, gestational age, body weight and Apgar scores. NT-proBNP levels, hematological parameters, LDH and CPK levels were studied in blood samples taken in the first hours after birth. The two groups were compared in terms of these parameters and it was investigated whether there was a relationship between the parameters.

Results: NT-proBNP levels were 3145 (372-7231) pg/ml in newborns born vaginally and 783 (401-6563) pg/ml in newborns born by cesarean section (p<0.05). CPK, LDH levels and white blood cell counts were higher in newborns born by vaginal delivery compared to newborns born by cesarean section (p<0.05). In addition, a positive correlation was found between NT-proBNP values and white blood cell counts (r =0.6, p=0.000).

Conclusion: NT-proBNP levels of those born vaginally are in the range of predefined reference levels and increased 4 times compared to those born through C/S. In addition, the relationship between NT-proBNP levels and biochemical markers and white blood cell counts suggests that vaginal delivery causes physiological stress and this may be related to postpartum adaptation.

Keywords

NT-proBNP, newborn, mode of delivery

Doğum Şeklinin Yenidoğanlarda NT-ProBNP Düzeylerine Etkisi

Abstract

Amaç: Yenidoğanlarda NT-proBNP düzeylerinin referans değerleri gebelik yaşı, postnatal yaş ve Apgar skorlarına bağlı olarak değişebilmektedir. Ancak, doğum şeklinin NT-proBNP düzeyleri ile ilişkili olup olmadığı halen belirsizdir. Bu nedenle çalışmamızda, vajinal doğum veya sezaryen sonrası doğan sağlıklı term yenidoğanlarda NT-proBNP düzeylerinin karşılaştırılması amaçlanmıştır.

Gereç ve Yöntemler: Çalışmaya hastanemizde doğan ve ğgestasyonel yaşı ≥38 hafta olan sağlıklı bebekler dahil edildi. Olgular (n=56) doğum şekline göre gruplandırıldı. Her iki grup cinsiyet, gebelik yaşı, vücut ağırlığı ve Apgar skorları açısından benzerdi. Doğum sonrası ilk saatlerde alınan kan örneklerinde NT-proBNP düzeyleri, hematolojik parametreler, LDH ve CPK düzeyleri çalışıldı. İki grup bu parametreler açısından karşılaştırıldı ve parametreler arasında ilişki olup olmadığı araştırıldı.

Bulgular: Vajinal yolla doğan bebeklerde NT-proBNP seviyeleri 3145 (372-7231) pg/ml ve sezaryen ile doğan bebeklerde 783 (401-6563) pg/ml idi (p<0.05). Vajinal yolla doğan bebeklerde sezaryen ile doğanlara göre CPK, LDH düzeyleri ve beyaz küre sayıları daha yüksekti (p<0.05). Ayrıca, NT-proBNP değerleri ile beyaz küre sayıları arasında pozitif korelasyon saptandı (r =0.6, p=0.000).

Sonuç: Vajinal yolla doğan yenidoğanlarda NT-proBNP düzeylerinin sezaryen ile doğanlara göre önceden tanımlanmış referans değer aralıkları içinde olduğu ve 4 kat arttığı görülmektedir. Ayrıca, NT-proBNP düzeyleri ile biyokimyasal belirteçler ve beyaz kan hücresi sayıları arasındaki ilişki, vajinal doğumun fizyolojik strese neden olduğunu ve bunun doğum sonrası adaptasyonla ilgili olabileceğini düşündürmektedir.

Keywords

NT-proBNP, yenidoğan, doğum şekli

References

• Rauh M, Koch A. Plasma N-terminal pro-B-type natriuretic peptide concentrations in a control population of infants and children. Clin. Chem. 2003;49(9):1563–4.
• Li S, Xiao Z, Li L, Hu B, Zhou Z, Yi S, et al. Establishment of normal reference values of NT-proBNP and its application in diagnosing acute heart failure in children with severe hand foot and mouth disease. Medicine (Baltimore).2018;97(36):e12218.
• Zigabea S, Gkiougkia E, Vrankenb L, Linthoutc CV, Seghaye MC. Early Human Development Biomarkers of neonatal stress assessment: A prospective study H. Rouatbia,Volume 137, October 2019, 104826
• Johns MC, Stephenson C. Amino-Terminal Pro–B-Type Natriuretic Peptide Testing in Neonatal and Pediatric Patients. Am. J. Cardiol. 2008;101(3A):S76–S81.
• Deng M, Lin C, Tang W, Zhu H, Zhang Y. Plasma N-terminal pro-B-type natriuretic peptide: Selecting the optimal heart failure marker in children of age up to 18 years. Int. J. Clin. Exp. Pathol. 2016;9(10):10756–62.
• Christou E, Iliodromiti Z, Pouliakis A,Rozeta Sokou R, Zantiotou M, Petropoulou C, et al. NT-proBNP Concentrations in the Umbilical Cord and Serum of Term Neonates: A Systematic Review and Meta-Analysis. Diagnostics (Basel).2022;12(6):1416.
• Cardo L, Álvarez E, García-García M, Álvarez FV. Amino-terminal proB-type natriuretic peptide reference values in umbilical cord blood. Clin. Chem. Lab. Med. 2020;58(9):179–81.
• Kocylowski RD, Dubiel M, Gudmundsson S, Sieg I, Fritzer E, Alkasi O, et al. Biochemical tissue-specific injury markers of the heart and brain in postpartum cord blood. Am. J. Obstet. Gynecol. 2009;200(3):e1–e273.
• Fortunato G, Carandente Giarrusso P, Martinelli P, Sglavo G, Vassallo M, Tomeo L, et al. Cardiac troponin T and amino-terminal pro-natriuretic peptide concentrations in fetuses in the second trimester and in healthy neonates. Clin. Chem. Lab. Med. 2006;44(7):834–6.
• Seong WJ, 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.
• Bar-Oz B, Lev-Sagie A, Arad I, Salpeter L, Nir A. N-terminal pro-B-type natriuretic peptide concentrations in mothers just before delivery, in cord blood, and in newborns. Clin. Chem. 2005;51(5):926–7.
• Bakker J, Gies I, Slavenburg B, Bekers O, Delhaas T, Dieijen-Visser VM. Reference values for N-terminal pro-B-type natriuretic peptide in umbilical cord blood. Clin. Chem. 2004;50(12):2465.
• Kerkelä R, Ulvila J, Magga J. Natriuretic Peptides in the Regulation of Cardiovascular Physiology and Metabolic Events. J. Am. Heart Assoc. 2015;4(10):e002423.
• Krüger C, Rauh M, Dörr HG. Immunoreactive renin concentrations in healthy children from birth to adolescence. Clin. Chim.Acta 1998;274(1):15–27.
• Albers S, Mir T, Haddad M, Läer S. N-Terminal pro-brain natriuretic peptide: Normal ranges in the pediatric population including method comparison and interlaboratory variability. Clin. Chem. Lab. Med. 2006;44(1):80–5.
• Iacovidou N, Briana DD, Boutsikou M, Gourgiotis D, Baka S, Vraila VM, et al. Perinatal changes of circulating N-terminal pro B-type natriuretic peptide (NT-proBNP) in normal and intrauterine-growth-restricted pregnancies. Hypertens Pregnancy 2007;26(4):463–71.
• Halse KG, Lindegaard ML, Goetze JP, Damm P, Mathiesen ER, Nielsen LB. Increased plasma pro-B-type natriuretic peptide in infants of women with type 1 diabetes. Clin. Chem. 2005;51(12):2296–302.
• Lee SM, Jun JK, Kim SA, Kang MJ, Song SH, Lee J, et al. N-terminal pro-B-type natriuretic peptide and cardiac troponin T in non-immune hydrops. J. Obstet. Gynaecol. Res. 2016;42(4):380–4.
• O’Brien F, Walker I.A. Fluid homeostasis in the neonate. Paediatr. Anaesth. 2014;24(1):49–59
• Koch A, Singer H. Normal values of B type natriuretic peptide in infants, children, and adolescents. Heart 2003;89(8):875–8.
• Finnemore A, Groves, A. Physiology of the fetal and transitional circulation. Semin. Fetal Neonatal Med. 2015;20(4):210–6.
• 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.
• Nir A, Lindinger A, Rauh M, Bar-oz B, Laer S, Schwachtgen L, et al. NT-Pro-B-type Natriuretic Peptide in Infants and Children: Reference Values Based on Combined Data from Four Studies Pediatr Cardiol 2009;30(1):3–8.
• Albers S, Mir TS, Haddad M, Läer S. N-Terminal pro-brain natriuretic peptide: Normal ranges in the pediatric population including method comparison and interlaboratory variability. Clin. Chem. Lab. Med. 2006;44(1):80–5.
• Flaherman VJ, Schaefer EW, Kuzniewicz MW, Li SX, Walsh EM, Paul IM. Early weight loss nomograms for exclusively breastfed newborns. Pediatrics. 2015;135(1):e16-23
• Goetze JP, Gore A, Møller CH, Steinbrüchel DA, Rehfeld JF, Nielsen LB. Acute myocardial hypoxia increases BNP gene expression. FASEB J. 2004;18(15):1928-30
• Lin LX, Mao QH, Zhang ZL, An CX, Kang XG. Plazma levels of N-Terminal Pro, Brain Natriuretic Peptide and Glycogen Phosphorylase İsoenzyme BB in neonates with asphyxia complicated by myocardial injury. Zhongguo Dang Dai Er Ke Za Zhi. 2010;12(4):252-5.
• Sparrow RL, Cauchi JA, Ramadi LT, Waugh CM, Kirkland MA. Influence of mode of birth and collection on WBC yields of umbilical cord blood units. Transfusion. 2002;42(2):210-5.
• Chirico G, Gasparoni A, Ciardelli L, Martinotti L, Rondini G. Leukocyte Counts in Relation to the Method of Delivery during the First Five Days of LifeBiol Neonate 1999;75(5):294–9.
• Lim FT, Scherjon SA, Beckhoven JM, Brand A, Kanhai H, Hermans JM, et al. Association of stress during delivery with increased numbers of nucleated cells and hematopoietic progenitor cells in umbilical cord blood (Am J Obstet Gynecol 2000;183(5): 1144-51.
• Hasan R, Inoue S, Banerjee A. Higher white blood cell counts and band forms in newborns delivered vaginally compared with those delivered by cesarean section. Am J Clin Pathol. 1993;100(2):116- 8.
• Herson VC, Block C, Eisenfeld LI, Maderazo E, Krause PJ. Effect of labor and delivery on neonatal polymorphonuclear leukocyte number and functionAm J Perinatol. 1992;9(4):285-8.