J Pediatr

. 2021 Sep 27;S0022-3476(21)00910-0. doi: 10.1016/j.jpeds.2021.09.034. Online ahead of print. https://pubmed.ncbi.nlm.nih.gov/34592260/

Increased proBNP during extracorporeal life support (ECLS) is associated with poor outcome in neonates with congenital diaphragmatic hernia

Florian Kipfmueller ¹, Julian Balks ², Kristina Gries ², Stefan Holdenrieder ³, Andreas Mueller ², Florian Kipfmueller ²Affiliations expand

• PMID: 34592260
• DOI: 10.1016/j.jpeds.2021.09.034

Abstract

Objectives: To evaluate the prognostic information derived from the daily measurements of proBNP in neonates with congenital diaphragmatic hernia (CDH) undergoing extracorporeal life support (ECLS).

Study design: Plasma proBNP was prospectively measured daily during the first week of ECLS using an electrochemiluminescence immunoassay. Patients (n=63) were allocated according to outcome: survivors (group 1, n=35); non-survivors with successful weaning (defined as survival for >12h after ECLS discontinuation) (group 2, n=16); non-survivors with unsuccessful weaning (group 3, n=12). ProBNP kinetics were compared using Kruskal-Wallis testing and correlated with pulmonary hypertension and cardiac dysfunction on echocardiography using the Spearman correlation coefficient.

Results: Infants in group 3 presented significantly higher proBNP values from day 3 to day 6 compared with group 1 and 2. Overall mortality among patients with the highest proBNP values on day 1 was 30.6% compared with 63% in those patients with at least one higher value on day 2 to day 7. In patients with a late increase (day 4 to day 7) in proBNP the mortality was 70%, compared with 32.6% in those with proBNP below the value on day 1. Weaning failure was 35% in patients with a late increase and 11.6% in those without a late increase. ProBNP correlated significantly with PH and cardiac dysfunction before and during ECLS.

Conclusions: Absolute proBNP values are associated with weaning failure but not overall mortality in neonates with CDH undergoing ECLS. Echocardiographic findings correlate well with proBNP values.

Keywords: BNP; cardiac dysfunction; extracorporeal life support; natriuretic peptides; pulmonary hypertension.

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