Longitudinal B-Type Natriuretic Peptide Levels Predict Outcome in Infants with Congenital Diaphragmatic Hernia
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Read the article on pubmed.ncbi.nlm.nih.gov ↗Article · Nov 2020 · 1 min read
In brief
In brief
Longitudinal BNP monitoring accurately predicts respiratory outcomes in CDH infants at 3-5 weeks of age, with declining thresholds (285→100→48 pg/mL) over time. Infants with poor outcomes show persistently elevated BNP levels and delayed decline compared to those with good respiratory outcomes at 56 days.
Written by the GCMD Library team from the article.
Objective: To evaluate B-type natriuretic peptide (BNP) as a longitudinal biomarker of clinical outcome in infants with congenital diaphragmatic hernia (CDH).
Study design: We conducted a retrospective study of 49 infants with CDH, classifying the cohort by respiratory status at 56 days, based on a proposed definition of bronchopulmonary dysplasia for infants ≥32 weeks' gestation: Good Outcome (alive with no respiratory support) and Poor Outcome (ongoing respiratory support or death). BNP levels were available at weeks 1-5 of age. Longitudinal BNP trends were assessed using mixed effects modeling. ROC curves were generated to identify BNP cut-offs maximizing correct outcome classification at each time point. Time to reach BNP cut-off by outcome was assessed using Kaplan-Meier curves for weeks 3-5.
Results: Twenty-nine infants (59%) had Poor Outcome. Infants with Poor versus Good Outcome were more likely to have liver herniated into the thorax (90% versus 50%, p=0.002) and undergo non-primary repair (93% versus 35%, P < .001). Mixed effects modeling demonstrated a differing decline in BNP over time by outcome group (p=0.003 for interaction). BNP accurately predicted outcome at 3-5 weeks (AUC 0.81-0.82). BNP cut-offs that maximized correct outcome classification decreased over time: 285 pg/mL, 100 pg/mL and 48 pg/mL at 3, 4 and 5 weeks. Time to reach cut-offs of 100 pg/mL and 48 pg/mL were longer in Poor Outcome (log-rank p-value 0.006 and <0.0001, respectively).
Conclusion: Elevated BNP accurately predicts Poor Outcome in infants with CDH at 3-5 weeks of age, with declining cut-offs over 3-5 weeks of age.
DOI: 10.1016/j.jpeds.2020.09.064