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All issues > Volume 61(2); 2018
B-type natriuretic peptide may have a role in the management of patent ductus arteriosus
- Corresponding author: Jang Hoon Lee. Department of Pediatrics, Ajou Univerisity School of Medicine, 206 World cup-ro, Yeongtong-gu, Suwon 16499, Korea. Tel: +82-31-219-5160, Fax: +82-31-219-5169, neopedlee@gmail.com
- Received July 24, 2017 Revised July 24, 2017 Accepted December 21, 2017
To the editor:
Management of patent ductus arteriosus (PDA) remains a challenge for neonatologists in the care of preterm infants. Considering previous findings suggesting that the use of cyclooxygenase inhibitors does not improve long-term prognosis1,2,3,4) and may cause serious side effects in extremely preterm infants, minimizing their use should be attempted, irrespective of various treatment guidelines recommending prophylactic or symptomatic use.
In recent decades, studies have examined diagnostic methods for PDA and evaluated hemodynamic changes by measuring cardiac biomarkers including B-type natriuretic peptide (BNP) in the neonatal intensive care unit.5,6,7) According to a recent meta-analysis, the measurement of BNP has diagnostic value for hemodynamic changes in premature infants with PDA.8)
Jeong et al.9) investigated the usefulness of BNP as a guide for additional ibuprofen dosing in the treatment of PDA in very preterm infants. Additional doses of ibuprofen after the initial dose were withheld if the level of BNP was <600 pg/mL and if the clinical symptoms of PDA improved. The authors avoided unnecessary dosing of ibuprofen without increasing adverse outcomes and showed that the early ductal closure rate on echocardiography was higher in the incomplete dosing group than in the complete dosing group. This report has great significance as it is the first to describe BNP measurement as a guide for individualized treatment of PDA in preterm infants. However, this study did not suggest the absolute level of BNP required to ensure closure of PDA. If data are available or the authors can respond to this issue, they should provide the information for use by other researchers.
- Notes
Conflicts of interest: No potential conflict of interest relevant to this article was reported.
- References
- 1. Cooke L, Steer P, Woodgate P. Indomethacin for asymptomatic patent ductus arteriosus in preterm infants. Cochrane Database Syst Rev 2003;(2): CD003745.
[Article] [PubMed] [PMC]2. Fowlie PW, Davis PG, McGuire W. Prophylactic intravenous indomethacin for preventing mortality and morbidity in preterm infants. Cochrane Database Syst Rev 2010;(7): CD000174.
[PubMed] [PMC]3. Ohlsson A, Walia R, Shah SS. Ibuprofen for the treatment of patent ductus arteriosus in preterm or low birth weight (or both) infants. Cochrane Database Syst Rev 2015;(2): CD003481.
[PubMed]4. Ohlsson A, Shah SS. Ibuprofen for the prevention of patent ductus arteriosus in preterm and/or low birth weight infants. Cochrane Database Syst Rev 2011;(7): CD004213.
[PubMed]5. Choi BM, Lee KH, Eun BL, Yoo KH, Hong YS, Son CS, et al. Utility of rapid B-type natriuretic peptide assay for diagnosis of symptomatic patent ductus arteriosus in preterm infants. Pediatrics 2005;115:e255–e261.
[Article] [PubMed]6. Lee JH, Shin JH, Park KH, Rhie YJ, Park MS, Choi BM. Can early Btype natriuretic peptide assays predict symptomatic patent ductus arteriosus in extremely low birth weight infants? Neonatology 2013;103:118–122.
[Article] [PubMed]7. Czernik C, Lemmer J, Metze B, Koehne PS, Mueller C, Obladen M. B-type natriuretic peptide to predict ductus intervention in infants <28 weeks. Pediatr Res 2008;64:286–290.
[Article] [PubMed]