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. 2014 Mar 11:14:68.
doi: 10.1186/1471-2431-14-68.

B-type natriuretic peptide and mortality in extremely low birth weight infants with pulmonary hypertension: a retrospective cohort analysis

Alain Cuna, Jegen Kandasamy, Brian Sims  1
Affiliations

B-type natriuretic peptide and mortality in extremely low birth weight infants with pulmonary hypertension: a retrospective cohort analysis

Alain Cuna et al. BMC Pediatr. .

Abstract

Background: B-type natriuretic peptide (BNP) is a strong predictor of mortality in adult patients with various forms of pulmonary hypertension (PH) and may be a strong prognostic marker in extremely low birth weight (ELBW) infants with bronchopulmonary dysplasia (BPD) associated PH as well. We sought to assess the relationship between BNP levels and all-cause mortality in a cohort of ELBW infants with BPD and PH.

Methods: We retrospectively identified ELBW infants with BPD and PH who had serum BNP levels measured as part of routine clinical care in the neonatal intensive care unit. Peak serum BNP levels were correlated with survival to discharge or death.

Results: Thirty-six ELBW infants (mean gestational age 26.0 ± 1.9 weeks and mean birth weight 740 ± 290 grams) with BPD and PH had available survival data and had serum BNP levels measured. Peak BNP level was significantly lower among infants who survived than among those who died (128 pg/ml, [IQR 23 to 463] vs. 997 pg/ml, [IQR 278 to 1770], P < 0.004). On multivariate Cox proportional hazard analysis, BNP predicted survival independent of age, gender, and BPD severity. Area under receiver operator characteristic analysis identified a BNP value of 220 pg/ml to have 90% sensitivity and 65% specificity in predicting mortality.

Conclusion: BNP estimation may be useful as a prognostic marker of all-cause mortality in ELBW infants with BPD associated PH.

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Figures

Figure 1
Figure 1
Box plots showing median levels of peak BNP of survivors versus non-survivors in a cohort of preterm infants with BPD-associated PH.
Figure 2
Figure 2
Receiver operating characteristic curve demonstrating that a BNP level of 220 pg/ml results in a sensitivity of 90% and a specificity of 65% for predicting mortality in preterm infants with BPD-associated PH.
Figure 3
Figure 3
Kaplan-Meier cumulative survival curves showing cumulative rates of survival for 36 preterm infants with BPD-associated PH stratified by the identified BNP cut-off value. Infants with BNP ≥ 220 pg/ml differed significantly from infants with BNP < 220 pg/ml.
See this image and copyright information in PMC

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