B-type natriuretic peptide concentrations to guide treatment of patent ductus arteriosus

• Published in: Archives of disease in childhood. Fetal and neonatal edition Vol. 94; no. 3; pp. F178 - F182
• Main Authors: Attridge, J T, Kaufman, D A, Lim, D S
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health 01.05.2009; BMJ Publishing Group LTD
• Subjects: Biomarkers - blood; Colleges & universities; Cyclooxygenase Inhibitors - administration & dosage; Ductus Arteriosus, Patent - drug therapy; Echocardiography; Female; Heart failure; Humans; Indomethacin - administration & dosage; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases - drug therapy; Investigations; Laboratories; Male; Natriuretic Peptide, Brain - blood; Pathology; Peptides; Prospective Studies; Pulmonary arteries; Review boards; Treatment Outcome; Virginia; Virginia
• ISSN: 1359-2998; 1468-2052
• DOI: 10.1136/adc.2008.147587

Objective:To determine whether b-type natriuretic peptide (BNP) concentrations can guide treatment of patent ductus arteriosus (PDA) to reduce the number of indomethacin doses without increasing morbidity.Design:Prospective, randomised, controlled trial.Setting:Single-centre referral neonatal intensive care unit.Patients:Infants with echocardiographic diagnosis of PDA. Infants with congenital heart disease or renal insufficiency were excluded.Interventions:BNP measurement and echocardiography were performed in all subjects before and after indomethacin treatment. The investigational group had BNP concentrations measured 12 and 24 h after the first dose (before the 2nd and 3rd doses of indomethacin). Indomethacin dosing was withheld in the BNP-guided group if the 12 or 24 h BNP concentrations were found to be <100 pg/ml.Main outcome measures:Number of doses of indomethacin given during the primary course of treatment (three doses every 12 h).Results:Sixty patients were randomly assigned to control (n = 30) and BNP-guided (n = 30) treatment groups. There was no difference between the groups with respect to gestational age (26+3 vs 25+5 weeks, respectively), Apgar scores, delivery method, gender or indomethacin prophylaxis. Median baseline and 48 h BNP concentrations did not differ between the groups (0 h: 500 vs 542 pg/ml; 48 h: 85 vs 126 pg/ml; control and BNP-guided groups, respectively). During primary indomethacin treatment, the BNP-guided group received fewer doses of indomethacin than controls (70 vs 88 doses, p<0.05). The rate of PDA ligation, intestinal perforation and chronic lung disease did not differ between groups.Conclusions:BNP-guided treatment reduced the number of primary indomethacin doses. There was no increase in PDA persistence or associated morbidity.