A clinical study of the brain natriuretic peptide in the diagnosis of myocardial injury after neonatal asphyxia / 中国新生儿科杂志

ABSTRACT

Objective To investigate the relationship between serum plasma brain natriuretic peptide ( BNP ) levels and myocardial injury in neoborns after asphyxia. Methods Neoborns who were admitted to Department of neonatology, Zhongnan Hospital, Wuhan University from December 2012 to December 2013 within 3 days after birth were considered. According to the number organized in chronological order every other case, newborns with neonatal asphyxia were assigned to observation group. The observation group were further divided into myocardial injury subgroup and non-cardiac injury subgroup according to the diagnostic criteria of myocardial injury. Newborns without neonatal asphyxia or neonatal cardiovascular diseases were assigned to control group. Exclusion criteria for control group were electrolyte disturbance, liver and kidney dysfunction. Blood sample was drawn from patients within 2 hours of admission to hospital and again on day 14. Serum BNP , creatine kinase isoenzyme ( CK-MB) , serum sodium and calcium were detected for further analysis. Results In 107 cases with neonatal asphyxia, 77 infants who had complete clinical records were selected as observation group, of which 36 met the diagnostic criteria of myocardial injury and assigned to myocardial injury subgroup. Non-cardiac injury subgroup consisted of the rest 41 cases in observation group. Twenty-two cases were enrolled to control group. Within 2 hours after admission, the serum BNP level of myocardial injury subgroup were significantly higher than those of the non-cardiac injury subgroup and the control group ( 2. 35 ± 0. 44 , 2. 12±0. 64, 1. 88±0. 27, log transformed, respectively, P＜0. 05). The BNP level of non-cardiac injury subgroup were also significantly higher than those of the control group. Serum BNP and CK-MB levels of observation group were positively correlated (r=0. 212,P=0. 030). After treatment, serum BNP level of myocardial injury subgroup at 14 days after admission decreased significantly, compared to the level at 2 hours within admission (P＜0. 05). When the cutoff value for infants with myocardial injury was 108. 05 pg/mL, the area under the ROC curve was 0. 753, with a sensitivity of 75. 0％ and a specificity of 64. 5％, positive predictive value was 56. 4％ and negative predictive value was 72. 3％. Conclusions Serum BNP level can reflect myocardial injury in neonates with asphyxia and can guide clinical treatment.