117 - B-type natriuretic peptide assay for individualized pharmacological treatment of patent ductus arteriosus in preterm infants

Recently, individualized echocardiography-guided pharmacological treatment has been proposed to reduce unnecessary doses of ibuprofen without increasing the reopening rate, rather than the standard 3-day course of pharmacological treatment. Plasma B-type natriuretic peptide (BNP) measurement have been proposed as a tool for the prediction and diagnosis of symptomatic PDA (sPDA) in preterm infants.

Objective:

To determine the feasibility of individualized BNP-guided pharmacological treatment, we planned to investigate the usefulness of plasma BNP levels, at 24 h ~ 48 h after the last dose of ibuprofen, to predict the need for additional dose of ibuprofen that reduces the reappearance of hemodynamically significant PDA (hsPDA) after completing the planned pharmacological treatment.

Design/Methods:

In NICU at Korea University Ansan Hospital, individualized pharmacological treatment for sPDA was performed, starting with the first dose of ibuprofen and withholding of additional ibuprofen doses, if clinical signs of hsPDA were improved before the next scheduled dose of ibuprofen. The treatment failure group defined as an infant whose clinical findings of hsPDA reappeared within 5 days were received additional doses of ibuprofen. Otherwise, the treatment success group included the infants who were successfully liberated from all clinical symptoms of hsPDA within 5 days. The BNP levels were assessed at 24h ~ 48h after the end of the pharmacological course.

Results:

Of the 76 preterm infants, 59 (77.6%) infants were assigned to the success group and 17 (22.4%) to the failure group. The gestational age and birth weight of the success group were not different with the failure group. The number of administered doses of ibuprofen was not different (2.4±1.3 vs 2.4±2.1). At 24h ~ 48h after the end of the pharmacological course, all infants showed no clinical signs of hsPDA despite ductal patency by echocardiography. The BNP level of the success group was significantly lower than that of the failure group (342 ±411 vs 617 ±532 pg/mL, p=0.018). The area under the curve of BNP to predict the need for additional dose of ibuprofen was high: 0.906 (95% confidence interval: 0.841-0.971). The best cutoff of BNP concentration was 378 pg/mL (sensitivity: 82.35%, specificity: 85.07%).

Conclusion(s):

Individualized BNP-guided pharmacological treatment for sPDA is clinically feasible. Plasma BNP level at 24 h ~ 48 h after the last dose of ibuprofen can be used as a guide to predict the need for additional dose of ibuprofen to reduce the reappearance of hsPDA after completing the planned pharmacological treatment.