J Pediatr
. 2020 Sep 27;S0022-3476(20)31256-7. doi: 10.1016/j.jpeds.2020.09.064. Online ahead of print. https://pubmed.ncbi.nlm.nih.gov/32997999/
Longitudinal B-Type Natriuretic Peptide Levels Predict Outcome in Infants with Congenital Diaphragmatic Hernia
Elyssa Guslits 1, Martina A Steurer 1, Hythem Nawaytou 1, Roberta L Keller 2Affiliations expand
- PMID: 32997999
- DOI: 10.1016/j.jpeds.2020.09.064
Abstract
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.
Keywords: List of key words: Pulmonary Hypertension; Pulmonary Vascular Disease.
Copyright © 2020. Published by Elsevier Inc.
