Plasma natriuretic peptides as predictors of hemodynamically significant patent ductus arteriosus in preterm neonates

The objective of this study was to determine whether the plasma levels of natriuretic peptides in preterm infants with patent ductus arteriosus [PDA] are predictors of the hemodynamic significance of the PDA shunt, and correlate them with clinical and echocardiographic assessment. Fifty preterm neonates, with a mean gestational age of 29.4 wk and weighing less than 1500 g, were enrolled in the study. Based on the clinical and echocardiographic findings, the hemodynamic influence of PDA shunt was classified as: large [8 infants], moderate [10 infants], small [12 infants] or no PDA [20 infants]. Plasma N-terminal atrial natriuretic peptide prohormone [Nt-pro ANP] and brain natrituretic peptide [BNP] were assessed using ELISA kits. The results showed that plasma levels of Nt-pro ANP and BNP significantly increased with the size of PDA shunt, and when compared to infants without PDA [P<0.05]. A value of Nt-pro ANP > 5000 pmol/l predicted a hemodynamically significant PDA with a sensitivity of 97% and a specificity of 90%, whereas a value of BNP > 25 pmol/l had a sensitivity of 87% and a specificity of 75%. Using echocardiographic left atrial/aortic root ratio [LA: Ao ratio] of 1.5 as a cut off gave a sensitivity of 75%. Using echocardiographic left atrial/aortic root ratio [LA: Ao ratio] of 1.5 as a cut off gave a sensitivity of 80% and a specificity of 95%. There were significant positive correlations between these studied parameters [P<0.01]. Plasma naturiuretic peptides [Nt-pro ANP and BNP] can be used as predictors of the hemodynamic significance of PDA in preterm neonates, and their measurement may be regarded as complementary to echocardiography in the assessment of PDA shunt and institution of appropriate treatment. Nt-pro ANP is more sensitive and specific predictor than BNP

effect of beclomethasone inhalation and oral montelukast sodium on serum IgE levels and clinical parameters in asthmatic children

IgE is considered to play a crucial role in allergic immune responses. Inhaled steroids and anti- leukotrienes are anti-asthmatic drugs which down regulate the immune responses. The present study was conducted to determine and compare the effects of a 6-months treatment with 600 mcg of inhaled beclomethasone and 5 mg of oral montelukast sodium on serum IgE, forced expiratory volume in 1[s] [FEV1] and clinical asthma scores in children with mild to moderate bronchial asthma. Sixty children with mild to moderate persistent asthma and sensitive to house-dust mites were randomly allocated to receive beclomethasone 600 mcg or montelukast 5 mg for 6 months. The level of serum total IgE, clinical parameters and FEV1 were measured before and after treatment. The results proved that, after 6 months of treatment, inhaled beclomethasone and montelukast, significantly decreased serum levels of total IgE, clinical asthma scores and FEV1 [P<0.01, P<0.01 and P<0.05 respectively]. There were no significant differences between inhaled beclomehtasone and oral montelukast in changes of all clinical parameters, FEV1 and serum total IgE levels. Both inhaled beclomethasone and oral montelukast decreased the serum IgE levels and improved the clinical parameters and pulmonary function in asthmatic children