BNP and troponin as screening biomarkers for PPHN in encephalopathic infants undergoing therapeutic hypothermia

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ESPR389
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Abstract: :

Background: The incidence of persistent pulmonary hypertension of the newborn (PPHN) is higher in encephalopathic infants undergoing therapeutic hypothermia (TH) compared to the general population and results in greater morbidity and mortality. Apart from ECHO, it would be beneficial to have early reliable biomarkers for PPHN diagnosis and management in this vulnerable population. Brain Natriuretic Peptide (BNP) is secreted by cardiomyocytes in response to right ventricular dysfunction and neonatal studies have shown higher levels in infants with PPHN. Troponin has been used in neonatal studies on hypoxic-ischemic encephalopathy (HIE) as marker of myocardial dysfunction. We hypothesize that BNP and troponin will be significantly elevated in infants undergoing TH that develop PPHN.   

Objective: To compare BNP and troponin levels in encephalopathic infants undergoing TH with and without PPHN. 

Design/Methods: We conducted a prospective observational study of patients who qualified for TH at NYU Langone Health or Bellevue Hospital Center from December 2019 to November 2020. PPHN was diagnosed clinically and confirmed with ECHO. Serum samples for BNP and troponin were collected on admission and at 12, 24, 48, 72 and 96 hours post TH initiation. Sample means of the two biomarkers were compared between infants on TH with and without PPHN. Other outcomes evaluated between the groups were hemodynamic changes, respiratory support and cardiac function. 

Results: Of the 40 infants in the study, 10 (25%) developed PPHN and 30 (75%) did not. There were no significant differences in baseline characteristics between the two groups with the exception of inhaled nitric oxide (iNO), milrinone and vasopressor use, which was higher in the PPHN group (Table 1). Heart rate and mean arterial pressure were similar in both groups but PPHN patients had significantly higher fiO2 requirement (p< 0.05) and significantly longer need for invasive mechanical ventilation throughout TH (p< 0.01, Table 1). Mean BNP and troponin levels were significantly higher in PPHN group peaking at 12 hours of TH and decreased following iNO initiation (Figure 1). On ECHO evaluation of cardiac function, 50% of patients with PPHN had depressed function compared to 8% of patients without PPHN (p=0.02). Despite notable cardiopulmonary compromise, infants with PPHN did not have more evidence of severe brain injury on MRI (Table 1). 

Conclusions: In our study, BNP and troponin were associated with PPHN and cardiac dysfunction. We conclude that BNP and troponin can be useful screening biomarkers for PPHN in encephalopathic infants undergoing TH especially in low resource settings where ECHO is not readily available and transfer to centers with iNO and ECMO capability is critical. In the future, we plan to recruit more patients to increase sample size and to investigate other biomarkers of hypoxic induced PPHN.  

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NYU Langone Health
NYU Langone Health
NYU Langone Health
NYU Langone Health

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