199 - Is serum BNP level predictive of hemodynamically significant PDA in extremely preterm neonates?

Publication Number: 199.5883

Juan Carlos. Hernandez, University of South Alabama, Mobile, AL, AL, United States; Diksha Shrestha, University of South Alabama Children's and Women's Hospital, Mobile, AL, United States; Gangajal Kasniya, University of South Alabama Children's and Women's Hospital, Mobile, AL, United States; Uzoma Obiaka, University of South Alabama Children's and Women's Hospital, Mobile, AL, United States; Saminathan Anbalagan, University of South Alabama Children's and Women's Hospital, Mobile, AL, United States; Fabien Eyal, University of South Alabama Children's and Women's Hospital, Mobile, AL, United States

Background: Hemodynamically significant patent ductus arteriosus (hsPDA) in preterm neonates is commonly diagnosed by the gold standard echocardiography. However, echo support and expertise of pediatric cardiologists may not be readily available at all centers. Serum brain natriuretic peptide (BNP), a quick test of cardiac overload, is reported to be variably associated with hsPDA in predominantly very preterm neonates and in the first 3 days of life. Hence, we sought to determine if serum BNP levels can aid in the diagnosis of echocardiographic hsPDA even in the extremely preterm population.

Objective: To assess the diagnostic accuracy of serum BNP level in predicting echocardiographic features of hsPDA in extremely preterm neonates (≤ 28 weeks) in the first week of life.

Design/Methods: Retrospective analysis of neonates born ≤ 28 weeks' gestation in a level IIIb NICU in Mobile, AL, between January 2023 and June 2024. All patients with serum BNP and echocardiography done on the same day, in the first 7 days of life, were included. Subsequently, they were classified into two groups based on the presence of hsPDA as defined by the narrowest PDA diameter >1.5mm and Left atrial/Aortic root diameter (LA/Ao) ratio >1.5 (Kulkarni, 2015). Various maternal and neonatal characteristics were collected. Standard statistical tests (Chi-squared and Mann-Whitney) were used, and a Receiver Operating Characteristic (ROC) analysis was performed to obtain the optimum cut-off value for serum BNP.

Results: Total of 53 infants were included, with the majority, 62.2%, born ≤ 24 weeks gestational age. Of them, 30 (56.6%) met the criteria for hsPDA. Baseline clinical characteristics did not differ between groups except for the infant’s sex (Table 1). Serum BNP was found to be higher in the hsPDA group compared to the non-hsPDA group (median 1470 pg/mL [IQR: 629 - 2580] vs median 298 [IQR: 131 - 1060], p=0.005). Using ROC analysis, a serum BNP level above 478 pg/mL had an 83.3% sensitivity and 69.6% specificity to predict hsPDA (p=0.005, AUC 0.725 [95% CI: 0.573 - 0.878], Youden Index = 0.53) (Figure 1). Predictive values and likelihood ratios are presented in Table 2.

Conclusion(s): The results of this limited study of extremely preterm neonates suggest that a serum BNP obtained in the first seven days of life may predict echocardiographic features of hsPDA. However, further validation in larger prospective studies is required.

Table 1. Neonatal and maternal characteristics.


Table 2. Serum BNP diagnostic accuracy tests.


Figure 1. ROC curve of serum BNP’s ability to predict hsPDA.