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Serum B-Type Natriuretic Peptide as a Predictor of Pulmonary Hypertension in Premature Infants with Bronchopulmonary Dysplasia

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Conference: 2014 International PHA Conference and Scientific Sessions

Release Date: 06.22.2014

Presentation Type: Abstracts

File Download: 2014 Conference Abstract - Tarif Choudhury

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Pulmonary hypertension (PHTN) is a significant risk factor for morbidity and mortality in premature infants with bronchopulmonary dysplasia (BPD). Echocardiograms are widely used in the surveillance of patients with BPD to monitor for progression to PHTN. B-type natriuretic peptide (BNP) is a cardiac biomarker that has been used to screen for pulmonary hypertension in adult and pediatric patients, however its utility has not been well demonstrated in the BPD population. It may be useful in identifying patients with PHTN in this subgroup, therefore aiding in therapeutic and prognostic parameters. Our objective was to determine the utility of BNP for identification of PHTN among premature infants with BPD.

Background: Pulmonary hypertension (PHTN) is a significant risk factor for morbidity and mortality in premature infants with bronchopulmonary dysplasia (BPD). Echocardiograms are widely used in the surveillance of patients with BPD to monitor for progression to PHTN. B-type natriuretic peptide (BNP) is a cardiac biomarker that has been used to screen for pulmonary hypertension in adult and pediatric patients, however its utility has not been well demonstrated in the BPD population. It may be useful in identifying patients with PHTN in this subgroup, therefore aiding in therapeutic and prognostic parameters. Our objective was to determine the utility of BNP for identification of PHTN among premature infants with BPD.

Methods: We retrospectively identified premature infants with BPD who underwent screening echocardiograms for suspected PHTN and had serum BNP levels measured within 2 days of an echocardiogram. Diagnosis of PHTN was given to those infants who met criteria by echocardiogram, while the remainder was labeled as having no PHTN.  An area under the curve (AUC) of receiver operating curve (ROC) analysis was used to help determine the optimum value to detect PHTN while comparing mean BNP values between groups.
Results: Fifty seven preterm infants with moderate and severe BPD (mean gestational age 26.1 ± 2.1 weeks) were identified. PHTN was defined by septal configuration and tricuspid regurgitation jet velocity. Septal contour score (SCS) is used to describe septal configuration and is utilized at our institution to help identify PHTN.  SCS of 1, 2 or 3 (1=mild, 2=moderate, 3=severe PHTN) are aimed to represent varying percentages of elevated RVSP whereas an SCS of 0 is considered normal.  By echocardiogram, 37 patients were diagnosed with PHTN and 20 without PHTN.  Mean BNP value of those with PHTN were higher than those without PHTN (91 [12-545.2] pg/mL versus 43 [11.4-136] pg/mL, P<0.016).  AUC of ROC analysis was 0.689 and the serum BNP proposed by this analysis could not be used as a reliable cutoff to test sensitivity or specificity.  However, when the cohort was re-assessed to identify moderate PHTN (using a SCS of  ≥ 2 to define PHTN), we found an AUC of 0.831 which revealed a cutoff BNP value of 59 pg/mL.  The resultant sensitivity was 90% and specificity of 68% for detecting PHTN with this cutoff value.  Using this definition, mean BNP values of those with PHTN were significantly higher than those without PHTN (177 [35-545.2] pg/mL versus 52 [12-120] pg/mL, P < 0.035).  

Conclusions: Serum BNP can be used to reliably predict moderate pulmonary hypertension in premature infants with moderate and severe BPD. It may also be used to trend all degrees of pulmonary hypertension in premature infants with moderate and severe BPD.   
Background: Pulmonary hypertension (PHTN) is a significant risk factor for morbidity and mortality in premature infants with bronchopulmonary dysplasia (BPD). Echocardiograms are widely used in the surveillance of patients with BPD to monitor for progression to PHTN. B-type natriuretic peptide (BNP) is a cardiac biomarker that has been used to screen for pulmonary hypertension in adult and pediatric patients, however its utility has not been well demonstrated in the BPD population. It may be useful in identifying patients with PHTN in this subgroup, therefore aiding in therapeutic and prognostic parameters. Our objective was to determine the utility of BNP for identification of PHTN among premature infants with BPD.

Methods: We retrospectively identified premature infants with BPD who underwent screening echocardiograms for suspected PHTN and had serum BNP levels measured within 2 days of an echocardiogram. Diagnosis of PHTN was given to those infants who met criteria by echocardiogram, while the remainder was labeled as having no PHTN. An area under the curve (AUC) of receiver operating curve (ROC) analysis was used to help determine the optimum value to detect PHTN while comparing mean BNP values between groups.
Results: Fifty seven preterm infants with moderate and severe BPD (mean gestational age 26.1 ± 2.1 weeks) were identified. PHTN was defined by septal configuration and tricuspid regurgitation jet velocity. Septal contour score (SCS) is used to describe septal configuration and is utilized at our institution to help identify PHTN.  SCS of 1, 2 or 3 (1=mild, 2=moderate, 3=severe PHTN) are aimed to represent varying percentages of elevated RVSP whereas an SCS of 0 is considered normal. By echocardiogram, 37 patients were diagnosed with PHTN and 20 without PHTN.  Mean BNP value of those with PHTN were higher than those without PHTN (91 [12-545.2] pg/mL versus 43 [11.4-136] pg/mL, P<0.016).  AUC of ROC analysis was 0.689 and the serum BNP proposed by this analysis could not be used as a reliable cutoff to test sensitivity or specificity.  However, when the cohort was re-assessed to identify moderate PHTN (using a SCS of  ≥ 2 to define PHTN), we found an AUC of 0.831 which revealed a cutoff BNP value of 59 pg/mL. The resultant sensitivity was 90% and specificity of 68% for detecting PHTN with this cutoff value. Using this definition, mean BNP values of those with PHTN were significantly higher than those without PHTN (177 [35-545.2] pg/mL versus 52 [12-120] pg/mL, P < 0.035).  

Conclusions: Serum BNP can be used to reliably predict moderate pulmonary hypertension in premature infants with moderate and severe BPD. It may also be used to trend all degrees of pulmonary hypertension in premature infants with moderate and severe BPD.   

Type: Clinical Science