PC1089: Urinary Nt-probnp for the Diagnosis of Hemodynamic Significant PDA in Preterm Neonates

Background: Echocardiogram is the gold standard for the diagnosis of hemodynamically significant patent ductus arteriosus (hsPDA) in preterm neonates, although it may not be readily available in all centers. Studies on plasma brain natriuretic peptide (BNP) or amino-terminal pro-B-type natriuretic peptide (NT-proBNP) have been shown to be useful in the diagnosis and management of hsPDA, but the evidence regarding the use of urinary NT-proBNP has not been summarized.

Methods: We performed a systematic review as described by the Cochrane Diagnostic Test Accuracy Working Group. Electronic databases, conference abstracts, and cross-references were searched. We included studies that evaluated urinary NT-proBNP and urinary NT-proBNP/Creatinine ratio (index tests) in preterm neonates with suspected hsPDA (participants) in comparison with echocardiogram (reference standard). The methodological quality of each study was assessed using the Cochrane Diagnostic Test Accuracy Working Group adaption of the Quality Assessment of Diagnostic-Accuracy Studies (QUADAS-2) tool.

Results: Four studies were included in the final analysis, in which three provided data for urinary NT-proBNP and three for urinary NT-proBNP/Creatinine ratio. The sensitivity, specificity and area under the curve (AUC) for urinary NT-proBNP for hsPDA was 79%, 71% and 0.8, respectively (Table 1). The sensitivity of urinary NT-proBNP/creatinine ratio ranged from 71-79%, and specificity from 76-100%, with AUC ranging from 0.81-0.85. Methodological quality assessment of included articles were adequate (Table 2). A meta-analysis was not possible due to very few studies providing data ( < 4 studies) and heterogeneity among the included studies.. We assessed the quality of evidence by GRADE rating as moderate to low.

Conclusion: Moderate to low quality of evidence suggests that Urinary NT-proBNP has modest accuracy for the diagnosis of a hemodynamically significant PDA. Although there is limited data, urinary NT-proBNP is a promising non-invasive biomarker for assessing hsPDA in preterm infants, especially in low resource settings, where an echocardiogram is not readily available for PDA assessment. We recommend a multi-center evaluation of urinary NT-proBNP to confirm its clinical utility in the management of hsPDA in preterm neonates, specifically to initiate therapy or follow response to therapy.