N-terminal-pro-brain natriuretic peptide: a guide for early targeted indomethacin therapy for patent ductus arteriosus in preterm Infants.

AIM: To determine whether N-terminal-pro-brain natriuretic peptide (NT-proBNP) level could be an effective guide for early targeted indomethacin therapy for patent ductus arteriosus (PDA) in preterm infants.

METHODS

An interventional study involved preterm infants, born at <33 weeks of gestation, who had plasma NT-proBNP levels obtained at day 2 of life. Indomethacin therapy was given if plasma NT-proBNP level was ≥10,180 pg/mL, the cut-off for predicting hemodynamic significant PDA (hsPDA). Echocardiograms were performed within 6 h at the time of plasma NT-proBNP collection and again at day 7, or whenever clinical hsPDA was suspected. Primary outcomes were the incidence of later hsPDA and unnecessary exposure rate to indomethacin.

RESULTS

Fifty infants were enrolled. On day 2, 19 (38%) infants had plasma NT-proBNP above the cut-off and received indomethacin therapy; none of them developed later hsPDA, while 1 of 31 infants with NT-proBNP below the cut-off level developed clinical hsPDA. Unnecessary exposure to indomethacin occurred in two infants (11%). Overall, no enrolled infants had either reopening of ductus or PDA ligation.

CONCLUSION

Using NT-proBNP level on day 2 as a guide for early targeted indomethacin therapy reduced later onset of hsPDA and the number of unnecessary exposures to indomethacin.