Troponin T, N-terminal pro natriuretic peptide and a patent ductus arteriosus scoring system predict death before discharge or neurodevelopmental outcome at 2 years in preterm infants

Abstract

Background: There is little consensus regarding the use of echocardiography in patent ductus arteriosus (PDA) treatment in preterm infants. The use of troponin T (cTnT) and N-terminal Pro-BNP (NTpBNP) in combination with echocardiography assessment may facilitate the development of a superior predictive model.

Objective: To investigate the ability of cTnT, NTpBNP and a PDA scoring system applied at 48 h of life to predict death before discharge and neurodevelopmental outcome at 2 years of age.

Design/methods: Infants <32 weeks and <1500 g were prospectively enrolled. Echocardiography evaluation coupled with cTnT and NTpBNP measurements were done at 48 h. The ductus arteriosus was scored (0-6) according to echocardiography markers of haemodynamic significance. Infants were assessed at 2 years using the Bayley scales and categorised into two groups: Severe Disability/Death before discharge or Normal/Mild Disability.

Results: Sixty infants with a median gestation of 27.7 weeks (26.2-29.4) and a median birth weight of 1.01 kg (0.86-1.22) were followed up to 2 years of age. Plasma cTnT and NTpBNP were higher in the Severe Disability/Death compared to the Normal/Mild Disability group (2.30 μg/l vs 0.19 μg/l, p<0.001; 9209 pmol/l vs 1664 pmol/l, p<0.001, respectively). The severe group had a higher PDA score compared to the mild and normal groups (5 vs 2, p<0.001).

Conclusion: Blood cTnT, NTpBNP and a PDA scoring system at 48 h may facilitate the identification of those infants with a PDA, who are at greatest risk of poor neurodevelopmental outcome at 2 years of age.