Evaluatıon of Copeptın, Mıd-Regıonal Proadrenomedullın and N-Termınal Pro-Brain Natrıuretıc Peptıt Levels in Anemıc Preterm Babıes: a Prospectıve Clınıcal Study

Yıl 2023, Cilt: 45 Sayı: 6, 884 - 891, 24.10.2023

Tuğba Barsan Kaya Ozge Aydemir Özge Sürmeli Onay Ayşe Neslihan Tekin

https://doi.org/10.20515/otd.1316497

Öz

Premature newborns in need of intensive care are among the most frequently transfused patient groups. Although there are studies in the literature examining the criteria used to make transfusion decision and the results of these criteria, there is no clear consensus on the indications for transfusion. The aim of this study was to evaluate the usefulness of NT-proBNP, copeptin and MR-proADM levels, which are sensitive to changes in cardiac output, in determining the need for transfusion in anemic infants. Twenty-four preterm infants who were being followed up in the neonatal intensive care unit and needed erythrocyte transfusion were included in the study as the Transfusion group and 23 preterm infants who had haematocrit >25 and no clinical findings indicating transfusion were included in the study as the Control group. No difference was found between pre- and post-transfusion copeptin, NT-ProBNP and MR-proADM levels in the transfusion group (p value 0.44, 0.64, 0.41, respectively). No significant difference was found between the pre-transfusion copeptin, NT-proBNP, and MR-proADM levels of the Transfusion group and the Control group (p=0.85, 0.75, 0.88, respectively). Although copeptin, NT-ProBNP and MR-proADM levels in patients with haemoglobin level below 8 mg/dl were found to be approximately 2-fold higher than those transfused with Hb level >8 mg/dl and the Control group, the difference between the groups was not statistically significant (p value 0.15, 0.47, 0.57, respectively). In the analysis of symptomatic and asymptomatic subgroups of the study group together with the Control group, no difference was found in copeptin, NT-ProBNP and MR-proADM levels (p value 0.81, 0.99, 0.93, respectively). Serological markers are guiding in many cases, but copeptin, NT-proBNP and MD-proADM in our study were not found to be useful in making transfusion decision in anaemia.

Anahtar Kelimeler

Anemia, neonatorum, red cell transfusion, biomarker

Anemik Preterm Bebeklerde Copeptin, Mid-Regional Proadrenomedullin ve N-Terminal Pro-Beyin Natriüretik Peptit Düzeylerinin Değerlendirilmesi: Prospektif Klinik Çalışma

Öz

Yoğun bakım ihtiyacı olan prematüre yenidoğanlar en sık transfüzyon yapılan hasta grupları arasındadır. Literatürde transfüzyon kararını vermekte kullanılan kriterler ve bu kriterlerin sonuçlarını inceleyen çalışmalar olsa da transfüzyon endikasyonları konusunda net bir fikir birliği yoktur. Bu çalışmanın amacı anemik bebeklerde transfüzyon ihtiyacını belirlemede kalp debisindeki değişikliklere duyarlı olan NT-proBNP, copeptin ve MR-proADM düzeylerinin kullanılabilirliğini değerlendirmektir. Yenidoğan yoğun bakım ünitesinde izlenmekte olan ve eritrosit transfüzyonu ihtiyacı olan 24 preterm bebek Transfüzyon grubu ve yenidoğan yoğun bakım ünitesinde izlenen, hematokrit (Hct)>%25 olan ve transfüzyon endikasyonu olabilecek klinik bulgusu olmayan 23 preterm bebek Kontrol Grubuna olarak çalışmaya dahil edildi. Transfüzyon grubunda transfüzyon öncesi ve sonrası copeptin, NT-ProBNP ve MR-proADM düzeyleri arasında fark saptanmadı (p değeri sırasıyla 0,44, 0,64, 0,41). Transfüzyon grubunun transfüzyon öncesi copeptin, NT-proBNP, ve MR-proADM düzeyleri kontrol grubunun düzeyleri ile kıyaslandığında anlamlı fark saptanmadı (sırasıyla p=0,85, 0,75, 0,88). Hemoglobin düzeyi 8 mg/dl altında olan hastalarda copeptin, NT-ProBNP ve MR-proADM düzeyleri Hb düzeyi >8mg/dl iken transfüzyon yapılanlar ve kontrol grubuna göre sayısal olarak yaklaşık 2 kat yüksek bulunmasına rağmen gruplar arasındaki fark istatistiksel olarak anlamlı değildi (p değeri sırasıyla 0,15, 0,47, 0,57). Çalışma grubunun semptomatik, asemptomatik alt gruplarının kontrol grubu ile birlikte olan analizinde copeptin, NT-ProBNP ve MR-proADM düzeyleri açısından fark saptanmadı (p değeri sırasıyla 0,81, 0,99, 0,93). Serolojik belirteçler pek çok durumda yol göstericidir ancak çalışmamızda yer alan Copeptin, NT-proBNP ve MD-proADM’in anemide, transfüzyon kararı vermede kullanışlı olmadığı kanaatine varılmıştır.

Anahtar Kelimeler

Anemi, yenidoğan, eritrosit transfüzyonu, biyobelirteç

Kaynakça

• 1. Bell EF, Strauss RG, Widness JA, et al. Randomized trial of liberal versus restrictive guidelines for red blood cell transfusion in preterm infants. Pediatrics, (2005). 115:1685–1691.
• 2. Kirpalani H, Whyte RK, Andersen C, et al. The Premature Infants in Need of Transfusion (PINT) study: a randomized, controlled trial of a restrictive (low) versus liberal (high) transfusion threshold for extremely low birth weight infants. J Pediatr, (2006). 149:301–307.
• 3. Whyte RK, Kirpalani H, Asztalos, et al. Neurodevelopmental outcome of extremely low birth weight infants randomly assigned to restrictive or liberal hemoglobin thresholds for blood transfusion. Pediatrics, (2009). 123:207–213.
• 4. Bell EF. When to transfuse the preterm infant. Arch Dis Child Fetal Neonatal Ed, (2008). 93:F469– 473.
• 5. Crowley M, Kirpalani H. A rational approach to red blood cell transfusion in the neonatal ICU. Curr Opin Pediatr, (2010). 22:151–157.
• 6. Alkalay AL, Galvis S, Ferry DA, Simmons CF, Krueger RC. Hemodynamic changes in anemic premature infants: are we allowing the hematocrits to fall too low? Pediatrics, (2003). 112(4):838 – 845
• 7. Kanmaz HG, Sarikabadayi YU, Canpolat E, Altug N, Oguz SS, Dilmen U. Effects of red cell transfusion on cardiac output and perfusion index in preterm infants. Early Hum Dev, (2013). 89(9):683-686.
• 8. Yasue H, Yoshimura M, Sumida H, et al. Localization and mechanism of secretion of B-type natriuretic peptide in comparison with those of A-type natriuretic peptide in normal subjects and patients with heart failure. Circulation, (1994). 90: 195-203
• 9. N.G. Morgenthaler, J. Struck, C. Alonso, A. Bergmann, Assay for the measurement of copeptin, a stable peptide derived from the precursor of vasopressin, Clin. Chem, 52 (2006). 112–119
• 10. Chan D, Ng LL. Biomarkers in acute myocardial infarction. BMC Med, (2010). 7;8-34.
• 11. Hume H, Blanchette V, Strauss RG, Levy GJ. A survey of Canadian neonatal blood transfusion practices. Transfusion Science, (1997). 1;18(1):71-80.
• 12. Perk Y, Atasay B, Çetinkaya M. Türk Neonatoloji Derneği Kan Ürünleri Transfüzyon Rehberi-2016.
• 13. Stockman JA. Anemia of prematurity: current concepts in the issue of when to transfuse. Pediatr Clin North Am, (1986)..33:111–119.
• 14. Hume H, Bard H. Small volume RBC transfusions for neonates. Transfus Med Rev. (1995).9:187–199.
• 15. Wardle SP, Yoxall CW, Crawley E, Weindling AM. Peripheral oxygenation and anemia in preterm babies. Pediatr Res, (1998). 44(1):125–131.
• 16. Izraeli S, Ben-Sira L, Harell D, et al. Lactic acid as a predictor for erythrocyte transfusion in healthy preterm infants with anemia of prematurity. J Pediatr, (1993).122(4):629 – 631.
• 17. Frey B, Losa M. The value of capillary whole blood lactate for blood transfusion requirements in anaemia of prematurity. Intensive Care Med. (2001). 27(1):222–227.
• 18. Howarth, C., J. Banerjee, and N. Aladangady, Red Blood Cell Transfusion in Preterm Infants: Current Evidence and Controversies. Neonatology, (2018). 114(1):7-16.
• 19. Miyoshi T, Hosoda H, Minamino N. Signifcance of atrial and brain natriuretic peptide measurements in fetuses with heart failure. Front Physiol,(2021). 12:654356.
• 20. Willis MS, Lee ES, Grenache DG. Effect of anemia on plasma concentrations of NT-proBNP. Clinica chimica açta, (2005).1;358(1-2):175-81.
• 21. Siebers P, Gembruch U, Merz WM, et al. Fetal NT-proBNP levels and their course in severe anemia during intrauterine treatment. Archives of Gynecology and Obstetrics, (2023). 26:1-1.
• 22. Tirmenstajn-Jankovic B, Dimkovic N, Perunicic-Pekovic G, et al. Anemia is independently associated with NT-proBNP levels in asymptomatic predialysis patients with chronic kidney disease. Hippokratia. (2013) Oct;17(4):307-312.
• 23. Hofbauer KH, Jensen BL, Kurtz A, Sandner P: Tissue hypoxygenation activates the adrenomedullin system in vivo. Am J Physiol – Regul Integr C, (2000). 278, 513–519.
• 24. A.J. de Bold, H.B. Borenstein, A.T. Veress, H. Sonnenberg, A Rapid and Potent Natriuretic Response to Intravenous Injection of Atrial Myocardial Extract in Rats, Reprinted from life sci., 281981 89–94 J Am Soc Nephrol. (2001)12:403-409.
• 25. Mayer B, Németh K, Krepuska M, Myneni VD, Maric D, Tisdale JF, Hsieh MM, Uchida N, Lee HJ, Nemeth MJ, Holmbeck K. Vasopressin stimulates the proliferation and differentiation of red blood cell precursors and improves recovery from anemia. Science translational medicine. (2017). Nov 29;9(418):eaao1632.
• 26. Winzeler B, Morin B, Refardt J, Imber C, Fenske W, Sailer CO, Holbro A, Christ‐Crain M. Low arginine vasopressin levels in patients with diabetes insipidus are not associated with anaemia. Clinical endocrinology. (2020) Oct;93(4):456-465.
• 27. Ohls, RK. Evaluation and treatment of anemia in the neonate. In: Christensen, RD., editor. Hematologic Problems of the Neonate. 1. Philadelphia, Pa: WB Saunders; (2000). 137-170.
• 28. John A. Widness; Pathophysiology of Anemia During the Neonatal Period, Including Anemia of Prematurity. Neoreviews November (2008). 9 (11): 520–525.