Sinan TÜFEKCİ, Ozgur KIZILCA, Erhan AYGÜN

YENİDOĞANLARDA PERSİSTAN PULMONER HİPERTANSİYON TANISI VE YÖNETİMİNDE N-TERMİNAL PROHORMON BRAİN NATRİÜRETİK PEPTİD

Amaç: Bu çalışmada, beyin natriüretik peptidinin (NT-proBNP) amino/N-terminal prohormonunun duzeylerinin ve yenidoğan kalıcı pulmoner hipertansiyon (PPHT) tanısında kullanımının araştırılması amaçlandı. Gereç ve Yöntem: Bu retrospektif kesitsel çalışmaya ≥34 gebelik haftasında doğan bebekler dahil edildi. Hasta grubuna PPHT tanısı konan 33 yenidoğan, kontrol grubuna ise 50 sağlıklı yenidoğan alındı. Hasta ve kontrol grupları, göbek kordonunda (UC) ve 72 saatlik yaşamda ölçülen plazma NT-proBNP seviyeleri açısından karşılaştırıldı. Bulgular: UC’da ve 72. saatte NT-proBNP seviyeleri, kontrollere kıyasla PPHT’lu yenidoğanlarda anlamlı derecede yüksekti (p<0,01). PPHT tanısı için UC NT-proBNP eşik değeri >2760,5 pg/ml, duyarlılık %90,7 ve özgüllük %96,6 (p<0,01) idi. Yetmişikinci saatte NT-proBNP için eşik değeri >1414 pg/ml, duyarlılık %95,9 ve özgüllük %91,2 idi (p<0,01). Kontrol grubunda ortalama UC NT-proBNP seviyeleri 1094,7±603 pg/ml ve 72 saatte ortalama NT-proBNP seviyeleri 875,7±423 pg/ml idi. Sonuç: NT-proBNP seviyeleri yaşamın ilk günlerinde yüksektir. Özellikle transtorasik ekokardiyografinin (TTE) yapılamadığı durumlarda, hipoksemik solunum yetmezliği ve inspire edilen oksijen fraksiyonu (FiO2) gereksinimi yüksek olan yenidoğanlarda PPHT tanı ve takibinde faydalıdır.

Anahtar Kelimeler:

NT-probnp, persistant pulmoner hipertansiyon, yenidoğan, göbek kordonu, ekokardiyografi

N-TERMINAL PROHORMONE OF BRAIN NATRIURETIC PEPTIDE IN THE DIAGNOSIS AND MANAGEMENT OF PERSISTENT PULMONARY HYPERTENSION IN NEWBORNS

Objective: This study aimed to investigate the levels and utility of amino/N-terminal prohormone of brain natriuretic peptide (NT-proBNP) in the diagnosis of neonatal persistent pulmonary hypertension (PPHT). Materials and Methods: Infants born at ≥34 weeks of gestation were included in this retrospective cross-sectional study. In total, 33 newborns diagnosed with PPHT were included in the patient group and 50 healthy newborns were included in the control group. Patient and control groups were compared in terms of plasma NT-proBNP levels measured in the umbilical cord (UC) and at 72 hours of life. Results: The NT-proBNP levels in UC and at 72 hours were significantly higher in neonates with PPHT compared to controls (p<0.01). For the diagnosis of PPHT, UC NT-proBNP cut-off value was >2760.5 pg/ml, sensitivity was 90.7%, and specificity was 96.6% (p<0.01). For NT-proBNP at 72 hours, the cut-off value was >1414 pg/ml, sensitivity was 95.9%, and specificity was 91.2% (p<0.01). The mean UC NT-proBNP levels were 1094.7±603 pg/ml and mean NT-proBNP levels at 72 hours were 875.7±423 pg/ml in the control group. Conclusion: NT-proBNP levels are high during the initial days of life. They are useful in the diagnosis and follow-up of PPHT in newborns with hypoxemic respiratory failure and high fraction of inspired oxygen (FiO2) requirement, especially in cases where transthoracic echocardiography (TTE) cannot be performed.

Keywords:

NT-proBNP, persistent pulmonary hypertension, newborn, umbilical cord, echocardiography,

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