206 - Diagnosing Hemodynamically Significant PDA using natriuretic peptides in Preterm Neonates

Poster Number: 206
Publication Number: 206.220

Ganga Gokulakrishnan, Baylor College of Medicine, Houston, TX, United States; Madhulika Kulkarni, Baylor College of Medicine, Conroe, TX, United States; Caraciolo J. Fernandes, Baylor College of Medicine, Houston, TX, United States; Mohan Pammi, Baylor College of Medicine, Bellaire, TX, United States

Background: Echocardiogram remains the gold standard for the diagnosis of hemodynamically significant patent ductus arteriosus (hsPDA) in preterm neonates. However, it is expensive in resource-limited settings. A previously published systematic review (Kulkarni et al 2015) revealed wide variability in the diagnostic accuracy and heterogeneity in the use of plasma brain natriuretic peptide (BNP) and amino-terminal pro-B-type natriuretic peptide (NT-proBNP) in diagnosing hsPDA. Since 2014, additional studies have been published on this topic.

Objective: To review the current literature and determine the diagnostic accuracy of plasma BNP and NT-proBNP in diagnosing hsPDA in preterm neonates.

Design/Methods: The systematic review was performed as recommended by the Cochrane Diagnostic Test Accuracy Working Group. Electronic databases, conference abstracts, and cross-references were searched from 2014-2021. Studies that evaluated BNP and NT-proBNP (index tests) in preterm neonates with suspected hsPDA in comparison with an echocardiogram (reference standard) were included. The methodological quality of each study was assessed using an adaptation of the Quality Assessment of Diagnostic-Accuracy Studies (QUADAS-2) tool. Meta-analyses were performed, and summary receiver operating characteristic curves were generated. 

Results: A total of 12 additional studies (3 for BNP and 9 for NT-proBNP) were included. With regard to the methodological quality of the studies included, most studies scored ‘low’ or ‘unclear’ for risk of bias and applicability concerns.  For BNP, a total of 13 studies were included with a summary sensitivity of 0.87 (95% CI: 0.78 to 0.92) and a summary specificity of 0.91 (95% CI: 0.82 to 0.96). For NT-proBNP, a total of 20 studies were included with a summary sensitivity of 0.90 (95% CI: 0.85 to 0.93) and a summary specificity of 0.88 (95% CI: 0.83 to 0.92) ( Figure 1).Conclusion(s): With the addition of recent studies, the summary sensitivity and summary specificity for both BNP and NT-proBNP are similar when compared to the results of the systematic review by Kulkarni et. al. Heterogeneity among studies needs to be further investigated through subgroup analysis with respect to test assay and age at the time of testing. The recent body of literature reveals increasing interest in studying the use of NT-proBNP as a diagnostic tool. Reference: Kulkarni M, Gokulakrishnan G, Price J, Fernandes CJ, Leeflang M, Pammi M. Diagnosing significant PDA using natriuretic peptides in preterm neonates: a systematic review. Pediatrics. 2015;135(2):e510-e525. doi:10.1542/peds.2014-1995.
Figure 1. Sensitivity and Specificity Forest Plots for BNP and NT-proBNPTP, true positives; FP, false positives; FN, false negatives; TN, true negatives.
Figure 2. Summary Receiver Operating Characteristic (SROC) plot for BNP (blue oval) and NT-proBNP (red diamond)The size of the symbols for BNP and NT-pro BNP studies are weighted for sample size. The summary curves and summary points (black dot for BNP and red dot for NT-proBNP) and 95% confidence intervals (dotted lines) derived from meta-analyses.