440 - Can Brain Natriuretic Peptide (BNP) and NT-proBNP Predict Outcomes in Congenital Diaphragmatic Hernia?

Publication Number: 3425.440

Arvind Mohan, TCU and UNTHSC School of Medicine, Bellaire, TX, United States; Tess A. Korte, Saint Louis University School of Medicine, Saint Louis, MO, United States; Joseph Hagan, Baylor College of Medicine, Houston, TX, United States; Srirupa Hari Gopal, Saint Louis University School of Medicine, St Louis, MO, United States

Background: Echocardiography is commonly used to assess pulmonary hypertension (PH) and cardiac function (CF) in congenital diaphragmatic hernia (CDH). Plasma biomarkers such as brain natriuretic peptide (BNP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) have been investigated as adjuncts and prognostic markers for PH and CF in CDH.

Objective: Our objective is to synthesize current evidence on the prognostic potential of plasma BNP and NT-proBNP in CDH.

Design/Methods: Our PROSPERO-registered protocol (CRD42024624160) involved a literature search based on predefined inclusion and exclusion criteria. Relevant data was extracted. The QUIPS tool was used to assess risk of bias. Quality of evidence was assessed using GRADE methodology.

Results: Nine studies were included (Figure 1), of which four studies used plasma BNP and five studies used plasma NT-proBNP. The studies varied in timing of collection, cut off and assay used. BNP was assessed as a prognostic marker for poor outcomes, such as predicting death or respiratory support at 56 days, with cut-offs decreasing with time: >188 pg/ml on day of life (DOL) 1 (sensitivity of 82% and specificity of 93%), >496 pg/ml at 1st week of life (sensitivity of 62% and specificity of 73%), >285 pg/mL at 3 weeks, 100 pg/mL at 4 weeks and 48 pg/mL at 5 weeks. Plasma NT-proBNP has also been correlated with poor outcomes, with cut-offs of >4682.5 pg/ml at 6 hours of life (HOL) (AUC 0.78, sensitivity of 69.2% and specificity of 75% for predicting death/ECMO), >11,500 pg/ml at 24 HOL (sensitivity of 100% and specificity of 67% for predicting death) and >21,000 pg/ml on day 2 on ECMO (AUC 0.707, sensitivity of 75% and specificity of 77.6% for predicting ECLS weaning failure) (Table 1). A meta-analysis could not be conducted due to heterogeneity in the studies. The QUIPS tool showed low risk of bias in all but one study. Assessment of evidence revealed low quality of evidence for both BNP and plasma NT-proBNP use in CDH.

Conclusion(s): Low quality of evidence suggests the prognostic utility of plasma BNP and NT-proBNP use in CDH. Further homogenous studies need to be conducted to better understand the accuracy of BNP and NT-proBNP use in CDH prognosis.

Figure 1: PRISMA Flow Diagram of Included Studies


Table 1: Characteristics of Included Studies
Area Under the Curve - (AUC), Brain Natriuretic Peptide - (BNP), Bronchopulmonary Dysplasia - (BPD), Congenital Diaphragmatic Hernia - (CDH), CDH Study Group - (CDHSG), Day of Life - (DOL), Extracorporeal Membrane Oxygenation - (ECMO), Hours of Life - (HOL), Not Applicable - (N/A), Neonatal Intensive Care Unit - (NICU), N-Terminal pro-B-Type Natriuretic Peptide - (NT-proBNP), Pulmonary Hypertension - (PH)