Background Brain natriuretic peptide (BNP) is a cardiac hormone mainly secreted by the cardiac ventricles in response to ventricular volume and/or pressure overload. In adults, BNP levels positively correlate with the pulmonary vascular resistance index, increasing in proportion to the degree of right ventricular dysfunction in pulmonary hypertension. To our knowledge there are no published reports on the use of BNP levels in the diagnosis and follow-up of persistent pulmonary hypertension in the newborn (PPHN).
Objectives To measure plasma levels of BNP in newborn infants with persistent pulmonary hypertension at diagnosis and recovery.
Methods The study included 12 newborns infants diagnosed with PPHN at 1 day of age, born at three different institutions in Bogota, Colombia, from January 2004 to August 2004. Clinical diagnosis of PPHN was confirmed by echocardiography and structural heart disease was ruled out. Systolic pulmonary pressure was estimated by echocardiography using the peak velocity of the tricuspid regurgitation jet. BNP levels were measured using the Triage® BNP Test (Biosite labs, San Diego CA) at entry and at the time of confirmation of resolution of PPHN by echocardiography (mean: 8.8 days).
Results The mean value of systolic pulmonary pressure (SPP) at diagnosis was: 62.7 mm Hg, (SD: 9.9). Mean value of SPP after resolution of PPHN was: 24.9 mm Hg (SD: 5.6). At diagnosis, BNP levels (mean: 434.6 pg/ml, SD: 386.9 pg/ml) were significantly higher (P value ≤ 0.001) than previously published normal values for 1 day of age (mean: 231.6 pg/ml, SD: 197.5 pg/ml). After resolution of PPHN, BNP levels (50.5 pg/ml, SD: 50.0 pg/ml) were not significantly different from previously published normal values for 1 week of age (mean: 48.4 pg/ml, SD: 49.1 pg/ml).There was a positive correlation between BNP levels and SPP (r = 0.53, p-value = 0.06).
Conclusions BNP levels may be useful in the diagnosis and follow-up of newborn infants with PPHN. A serial BNP level measurement in a larger number of newborn infants with PPHN is in its way.
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