NT-proBNP Levels Improve the Ability of Predicting a Hemodynamically Significant Patent Ductus Arteriosus in Very Low-Birth-Weight Infants.

PURPOSE: A hemodynamically significant Patent ductus arteriosus (HsPDA) in premature infants is known to be associated with significant morbidity. Recently brain natriuretic peptides and superior mesenteric artery (SMA)-resistive indices have been used to effectively diagnose HsPDA. OBJECTIVE: To assess the sensitivity and specificity of N-terminal proBNP (NT-proBNP) in predicting an HsPDA diagnosed by clinical and echocardiographic criteria including pulsatility index (PI) of SMA. MATERIALS AND METHODS: All preterm neonates <1500 g were evaluated with echocardiograms and NT-proBNP levels on the 3(rd) to 5(th) day of life and then every week until the echo showed either a closed PDA or non-HsPDA. RESULTS: Sixty-nine babies with mean gestational age of 27 weeks were included in the study. NT-proBNP levels were significantly higher in the HsPDA group (n=22) with a mean±SEM of 24420±3190 compared to 3072±332 in the non-HsPDA group (n=47) (P<0.001). NT-pro BNP level of 5900 pg/ml had 96% sensitivity and 90% specificity of predicting HsPDA. CONCLUSIONS: With frequently changing hemodynamics in low-birth weight infants, including NT-proBNP and PI of SMA improve the ability of assessing the effects of a HsPDA and will help timing of intervention.

Improvement of cardiac auscultation skills in pediatric residents with training.

Cardiac murmurs, most of which are harmless, are present in more than 50% of children. Good auscultation skills are required to prevent unnecessary referrals. The auscultation skills of a group of 21 pediatric residents were assessed. Based on their identification of key features such as S1, S2, timing, grade, location, quality of the murmur, and any extra sounds, residents were asked to make a clinical diagnosis. The overall diagnostic accuracy for all residents was 30% and improved with years of training. The average score for correctly identified key features was 46% with no significant improvement with year of training. Residents who had completed a cardiology rotation scored better than the others (41% vs 18% for correct diagnosis). Clinical auscultation skills of pediatric residents in our institution showed significant improvement with training, especially in the ability to recognize a harmless heart murmur.

Accuracy of parental reporting of immunization.

This study was undertaken to evaluate the reliability of parental reporting of their children's immunization status. One hundred eight consecutively admitted children to Brookdale University Hospital and Medical Center were sampled during October and November 2001. Review of the immunization record, recording the immunizations documented, and matching it with the parents' report was done for children in whom the parents brought the cards. The primary care physician was contacted to verify the immunization status for children for whom the parents did not bring the card during hospitalization or for whom there was a mismatch between the card and the parents' report. The study included 100 patients (8 were excluded). Forty-nine patients had their immunization cards on admission; 18 brought the cards later during the hospital stay. Of the 100 parents questioned, 98 stated that their children are up to date and 2 stated that their children are missing vaccinations. Of the 98 parents who stated that their children are up to date, 2 were found not to be up to date. Ninety-eight percent of parents were aware of their children's immunization status and were accurate with their reporting. Parents are knowledgable of their children's immunization status (98% parental accuracy) and their statements can be relied on during history-taking. It is important for each child to have a primary care physician.