Usefulness of Plasma B-Type Natriuretic Peptide Levels in Predicting the Need for an Additional Ibuprofen Dose in Hemodynamically Significant Patent Ductus Arteriosus

Objective: We investigated the usefulness of the plasma B-type natriuretic peptide (BNP) levels measured 24 hours after the last ibuprofen dose in predicting the need for an additional dose to prevent the recurrence of symptomatic patent ductus arteriosus (PDA) following completion of the planned pharmacological treatment.Methods: Seventy-one preterm infants with hemodynamically significant (hs) PDA, whose plasma BNP levels were measured just before and 24 hours after the last ibuprofen dose were enrolled.Subjects were classified as the sufficient dosing group (n=50, no hsPDA recurrence within 5 days after the last ibuprofen dose) or the insufficient dosing group (n=21, hsPDA recurrence within 5 days requiring additional ibuprofen).Results: Plasma BNP levels 24 hours after the last dose were significantly lower in the sufficient dosing group than in the insufficient dosing group (177 89-310 vs. 483 222-1,027 pg/mL, P=0.006).The area under the receiver operating characteristic curve for plasma BNP levels in predicting the need for an additional ibuprofen dose was 0.890 (95% confidence interval, 0.812-0.967;P462 pg/mL (sensitivity 71.4%, specificity 82.0%).Conclusion: Plasma BNP levels measured 24 hours after completion of ibuprofen therapy can serve as a useful biomarker for identifying preterm infants at risk of recurrent hsPDA who may require additional ibuprofen treatment.These findings support the potential for individualized, BNP-guided therapy to reduce hsPDA recurrence and avoid unnecessary drug exposure.