Kord Kanı ve Yenidoğan Plazma Beyin Natriüretik Peptid Düzeyleri ile Doğum Şekli Arasındaki İlişki

Öz

Fetal-neonatal adaptasyon birçok kompleks mekanizmayı içermektedir. Kardiyovasküler biyomarkırlar perinatal geçiş dönemindeki fetal ve anne fizyolojisinin anlaşılmasına yardımcı olabilir. Bu çalışmada amacımız sağlıklı, zamanında doğmuş yenidoğanlarda doğum şekli ile beyin natriüretik peptid (BNP) düzeyleri arasındaki ilişkiyi değerlendirmektir. Çalışmaya vajinal doğum (n=25) ve sezaryen (n=23) ile doğan 48 yenidoğan dahil edilmiştir. Kordon kanı örneklerinde plazma BNP düzeyleri ölçülmüş ve ayrıca yaşamın ilk gününde yenidoğanların antropometrik ölçümleri ve fizik muayeneleri yapılmıştır. Doğumdan 3 gün sonra BNP düzeyleri ölçümü ve klinik değerlendirme tekrarlanmıştır. Medyan kord ve bebek BNP düzeyleri vajinal ve sezaryen doğumlarda benzer bulunmuştur. Vajinal doğumlarda medyan kord ve bebek BNP düzeyleri arasında fark bulunmamıştır [sırasıyla 54,0 pg/ml (q1-q3: 40,0-111,5) ve 66,0 pg/ml (q1-q3: 43,0-90,0), p=0,619]. Ancak sezaryen doğumlarda, medyan bebek BNP düzeyi, medyan kord BNP düzeyinden istatistiksel olarak anlamlı derecede yüksek bulunmuştur [56,0 pg/ml (q1-q3: 39,0-84,0) ve 75,0 pg/ml (q1-q3: 54,0-145,0), p=0,027]. Komplike olmayan vajinal doğumlar, yüksek BNP seviyeleri ve dolayısıyla fetal kalp sıkıntısı ile ilişkili bulunmamıştır. Elektif sezaryen doğumlarda 3. günde artan BNP düzeyleri postnatal pulmoner ve kardiyak adaptasyonun gecikmesinin habercisi olabilir.

Anahtar Kelimeler

• Beyin natriüretik peptidi (BNP)
• vajinal doğum
• sezaryen
• doğum şekli
• yenidoğan

The Association Between Umbilical Cord Blood and Neonatal Plasma Brain Natriuretic Peptide Levels and Mode of Delivery

Öz

Fetal-to-neonatal adaptation involves many complex mechanisms. Cardiovascular biomarkers may help to understand fetal and maternal physiology in pregnancy and during the perinatal transition period. In this present study, our aim was to assess the association between delivery type and brain natriuretic peptide (BNP) levels in healthy full-term neonates. Forty-eight neonates born by vaginal delivery (n=25) and cesarean section (n=23) were included in the study. Plasma BNP levels were measured at cord blood samples. In addition antropometric measurements and physical examination were evaluated at first day of life. BNP levels measure and clinical evaluation were repeated 3 days later after birth. The median cord and infant BNP levels were similar in vaginal and cesarean delivery. There was no difference between the median cord and infant BNP levels in vaginal deliveries [54.0 pg/ml (q1-q3: 40.0-111.5) and 66.0 pg/ml (q1-q3: 43.0-90.0) respectively, p=0.619]. However, the median infant BNP level was statistically significantly higher than the median cord BNP level [56.0 pg/ml (q1-q3: 39.0-84.0) and 75.0 pg/ml (q1-q3: 54.0-145.0), p=0.027] in cesarean deliveries. Uncomplicated vaginal deliveries were not associated with high BNP levels and thus fetal cardiac distress. Increased levels of BNP levels on the 3rd day in elective cesarean deliveries may be predictive of delayed postnatal pulmonary and cardiac adaptation.

Anahtar Kelimeler

• Brain natriüretic peptid (BNP)
• vaginal delivery
• cesarean section
• mode of delivery
• newborn

Kaynakça

1. 1. Sinha SK, Donn SM, editors. Fetal-to-neonatal maladaptation. Seminars in Fetal and Neonatal Medicine; 2006: Elsevier.
2. 2. Blohm ME, Arndt F, Fröschle GM, Langenbach N, Sandig J, Vettorazzi E, et al. Cardiovascular biomarkers in amniotic fluid, umbilical arterial blood, umbilical venous blood, and maternal blood at delivery, and their reference values for full-term, singleton, cesarean deliveries. Frontiers in pediatrics. 2019;7:271.
3. 3. Sudoh T, Kangawa K, Minamino N, Matsuo H. A new natriuretic peptide in porcine brain. Nature. 1988;332:78-81.
4. 4. Calzetta L, Orlandi A, Page C, Rogliani P, Rinaldi B, Rosano G, et al. Brain natriuretic peptide: much more than a biomarker. International journal of cardiology. 2016;221:1031-8.
5. 5. Cantinotti M, Storti S, Parri MS, Prontera C, Murzi B, Clerico A. Reference intervals for brain natriuretic peptide in healthy newborns and infants measured with an automated immunoassay platform. Clin Chem Lab Med. 2010;48:697-700.
6. 6. 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;30:3-8.
7. 7. Tauber KA, Doyle R, Granina E, Munshi U. B‐type natriuretic peptide levels normalise in preterm infants without a patent ductus arteriosus by the fifth postnatal day. Acta Paediatrica. 2016;105:e352-e5.
8. 8. Mir TS, Laux R, Hellwege HH, Liedke B, Heinze C, von Buelow H, et al. Plasma concentrations of aminoterminal pro atrial natriuretic peptide and aminoterminal pro brain natriuretic peptide in healthy neonates: marked and rapid increase after birth. Pediatrics. 2003;112:896-9.

9. 9. Reynolds EW, Ellington JG, Vranicar M, Bada HS. Brain-type natriuretic peptide in the diagnosis and management of persistent pulmonary hypertension of the newborn. Pediatrics. 2004;114:1297-304.
10. 10. Behere S, Alapati D, McCulloch MA. Screening echocardiography and brain natriuretic peptide levels predict late pulmonary hypertension in infants with bronchopulmonary dysplasia. Pediatric Cardiology. 2019;40:973-9.
11. 11. Carella DM. Brain Natriuretic Peptide: It’s Not About the Brain or Just Another Smart Polypeptide—It’s About the Heart. Neonatal Network. 2015;34:355-60.
12. 12. Farombi-Oghuvbu I, Matthews T, Mayne PD, Guerin H, Corcoran JD. N-terminal pro-B-type natriuretic peptide: a measure of significant patent ductus arteriosus. Arch Dis Child Fetal Neonatal Ed. 2008;93:F257-60.
13. 13. Itoh H, Sagawa N, Hasegawa M, Okagaki A, Inamori K, Ihara Y, et al. Brain natriuretic peptide levels in the umbilical venous plasma are elevated in fetal distress. Biol Neonate. 1993;64:18-25.
14. 14. Aydemir O, Aydemir C, Sarikabadayi YU, Altug N, Erdeve O, Uras N, et al. The role of plasma N-terminal pro-B-type natriuretic peptide in predicting the severity of transient tachypnea of the newborn. Early Hum Dev. 2012;88:315-9.
15. 15. Osman AM, El-Farrash RA, Mohammed EH. Early rescue Neopuff for infants with transient tachypnea of newborn: a randomized controlled trial. J Matern Fetal Neonatal Med. 2017:1-7.
16. 16. Salas GL, Jozefkowicz M, Goldsmit GS, Disa G, Biochemistb AR, Biochemistb SR, et al. B-type natriuretic peptide: Usefulness in the management of critically-ill neonates. Arch Argent Pediatr. 2017;115:483-9.
17. 17. Clark RH. The epidemiology of respiratory failure in neonates born at an estimated gestational age of 34 weeks or more. J Perinatol. 2005;25:251-7.
18. 18. van den Berg A, van Elburg RM, van Geijn HP, Fetter WP. Neonatal respiratory morbidity following elective caesarean section in term infants. A 5-year retrospective study and a review of the literature. Eur J Obstet Gynecol Reprod Biol. 2001;98:9-13.
19. 19. Makihara K, Hata T, Hata K, Kitao M. Echocardiographic assessment of systolic time intervals in vaginal and cesarean delivered neonates. Am J Perinatol. 1993;10:53-7.
20. 20. Aldudak B, Kervancioglu M. Effect of mode of delivery on postnatal decline in pulmonary artery pressure. Saudi Med J. 2011;32:579-83.
21. 21. Rodriguez D, Garcia-Rivas G, Laresgoiti-Servitje E, Yañez J, Torre-Amione G, Jerjes-Sanchez C. B-type natriuretic peptide reference interval of newborns from healthy and pre-eclamptic women: A prospective, multicentre, cross-sectional study. BMJ open. 2018;8:e022562.
22. 22. 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;281:907-12.
23. 23. Rouatbi H, Zigabe S, Gkiougki E, Vranken L, Van Linthout C, Seghaye M-C. Biomarkers of neonatal stress assessment: A prospective study. Early Human Development. 2019;137:104826.
24. 24. Blohm ME, Arndt F, Sandig J, Diehl W, Zeller T, Mueller GC, et al. Cardiovascular biomarkers in paired maternal and umbilical cord blood samples at term and near term delivery. Early Human Development. 2016;94:7-12.
25. 25. Martelius L, Janer C, Suvari L, Helve O, Lauerma K, Pitkanen O, et al. Delayed lung liquid absorption after cesarean section at term. Neonatology. 2013;104:133-6.
26. 26. Okumus N, Atalay Y, Onal EE, Turkyilmaz C, Senel S, Gunaydin B, et al. The effects of delivery route and anesthesia type on early postnatal weight loss in newborns: the role of vasoactive hormones. J Pediatr Endocrinol Metab. 2011;24:45-50