Session: Neonatal Hemodynamics and Cardiovascular Medicine 1
449 - Comparison of the predictive ability for PDA surgery between early serum NT-proBNP level and echocardiographic PLASE score
Sunday, April 26, 2026
9:30am - 11:30am ET
Publication Number: 3434.449
Morita Yusuke, Kanagawa Children's Medical Center, Yokohama, Kanagawa, Japan; Satoshi Masutani, Saitama Medical Center, Saitama Medal University, Kawagoe, Saitama, Japan; Kyongsun Pak, National Center for Child Health and Development, Setagaya, Tokyo, Japan; Tomoko Saito, Kanagawa Children’s Medical Center, Yokohama, Kanagawa, Japan; Seiichi Tomotaki, Kyoto University Hospital, Kyoto, Kyoto, Japan; Tohru Kobayashi, Yokohama City University, Setagaya-ku, Tokyo, Japan; Tetsuya Isayama, National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan; Katsuaki Toyoshima, Kanagawa children's Medical Center, Yokohama, Kanagawa, Japan
Fellow Kanagawa Children's Medical Center Yokohama, Kanagawa, Japan
Background: The serum N-terminal pro-brain natriuretic peptide (NT-proBNP) level in the early postnatal period is considered useful for diagnosing hemodynamically significant patent ductus arteriosus (PDA); however, there are no reports on whether it can predict the need for surgery. The PLASE score is a predictive model for PDA surgery using three simple echocardiographic indices at day 3 and gestational age, showing a high predictive ability. Objective: This study aimed to compare the predictive abilities of the early NT-proBNP and PLASE scores. Design/Methods: Infants born at 23-29 weeks of gestation from 2019 to 2024 were included in the study. We collected the highest serum NT-proBNP levels from days 2 to 4 and the echocardiographic indices (PDA diameter, left pulmonary artery end-diastolic velocity, and left atrial aortic diameter ratio) on day 3. The background data were summarized by dividing the patients into groups with and without PDA surgery. The area under the receiver operating characteristic curve (ROC-AUC) of each prediction model was calculated using Model 1 (PLASE score), Model 2 (NT-proBNP), and Model 3 (NT-proBNP + weeks of gestational age). We compared the ROC-AUC of Models 2 and 3 with that of Model 1 as the control. The continuous net reclassification improvement (cNRI) and integrated discrimination improvement (IDI) for Models 2 and 3, with Model 1 as a control, were calculated for risk reclassification. Calibration plots and intraclass correlation coefficients (ICCs) were calculated for all three models. Results: The total number of patients was 126; of these, 23 underwent PDA surgery and 103 did not. The mean gestational age were 24.6 and 26.6 weeks, respectively, and the mean birth weights were 726 and 891 g, respectively. The ROC-AUC for each model was 0.829 (95% confidence interval [CI], 0.748-0.910), 0.669 (95% CI, 0.539-0.798) (p=0.020) and 0.812 (95% CI, 0.722-0.903) (p=0.696), respectively. The cNRI with Model 1 as the control was -1.051 for Model 2 and -0.074 for Model 3, and the IDI was -0.185 for Model 2 and -0.004 for Model 3. The ICC was 0.841 for Model 1, 0.268 for Model 2, and 0.907 for Model 3.
Conclusion(s): Although early postnatal NT-proBNP alone showed a lower predictive ability for PDA surgery than the PLASE score, its predictive performance was comparable to the PLASE score when gestational age was included. NT-proBNP levels and gestational age can be readily obtained without echocardiographic expertise. Further validation in other cohorts would be worthwhile.
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