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  • Title: N-terminal-pro-brain natriuretic peptide: a guide for early targeted indomethacin therapy for patent ductus arteriosus in preterm Infants.
    Author: Nuntnarumit P, Chongkongkiat P, Khositseth A.
    Journal: Acta Paediatr; 2011 Sep; 100(9):1217-21. PubMed ID: 21457304.
    Abstract:
    AIM: To determine whether N-terminal-pro-brain natriuretic peptide (NT-proBNP) level could be an effective guide for early targeted indomethacin therapy for patent ductus arteriosus (PDA) in preterm infants. METHODS: An interventional study involved preterm infants, born at <33 weeks of gestation, who had plasma NT-proBNP levels obtained at day 2 of life. Indomethacin therapy was given if plasma NT-proBNP level was ≥10,180 pg/mL, the cut-off for predicting hemodynamic significant PDA (hsPDA). Echocardiograms were performed within 6 h at the time of plasma NT-proBNP collection and again at day 7, or whenever clinical hsPDA was suspected. Primary outcomes were the incidence of later hsPDA and unnecessary exposure rate to indomethacin. RESULTS: Fifty infants were enrolled. On day 2, 19 (38%) infants had plasma NT-proBNP above the cut-off and received indomethacin therapy; none of them developed later hsPDA, while 1 of 31 infants with NT-proBNP below the cut-off level developed clinical hsPDA. Unnecessary exposure to indomethacin occurred in two infants (11%). Overall, no enrolled infants had either reopening of ductus or PDA ligation. CONCLUSION: Using NT-proBNP level on day 2 as a guide for early targeted indomethacin therapy reduced later onset of hsPDA and the number of unnecessary exposures to indomethacin.
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