الفهرس 
NEONATAL RESPIRATORY DISTRESSOnly 14 pages are availabe for public view
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Abstract
Respiratory distress (RD) remains one of the most common neonatal
problems, occurring in approximately 7% of babies during the neonatal period.
The underlying etiology of respiratory distress in a newborn varies and
does not always lie within the lungs. Cardiac diseases is considered one of the
most common extra pulmonary causes of neonatal RD. the differentiation of
cardiac causes from pulmonary causes of such distress may be challenging.
Also, identification of cardiac problems should be accurate so that the
appropriate care can be initiated promptly.
Natriuretic peptides (NPs) are cardiac biomarkers that give a general
indication of the heart structure and function in the newborn infants. The
ventricular myocardium is considered the main site for synthesis of brain
natriuretic peptide (BNP) and release in response to pressure or volume
overload, Pro-Brain Natriuretic Peptide is cleaved into BNP and NT-proBNP.
There are excellent correlation between BNP and NT-proBNP. NT-proBNP
does not pass the blood-placenta barrier which means that changes in neonatal
body are autonomous. a good correlation between urinary and plasma NTproBNP
levels were showed in parallel measurements, therefore the urine
represents a non-invasive source of NT-proBNP.
Previous studies in pediatrics have shown that measurement of plasma
BNP or NT-proBNP levels with a bedside test is valuable in differentiating
cardiac from pulmonary causes of RD.
Objective: The objective of this study was to evaluate usefulness of
urinary NT-proBNP as a diagnostic and prognostic marker to differentiate
between cardiac and pulmonary causes of neonatal respiratory distress (RD).
Method: Urine collected non-invasively by urine collecting bags and
NT-proBNP levels was measured in 90 full term neonates The first sample was
taken during the first 48 of admission and the second sample was taken on the
5th day: 60 patients with RD (30 patients with RD due to cardiac causes and 30
patients due to pulmonary causes) and 30 healthy controls. RD severity was
assessed using the Downes Score. Chest x-ray, echocardiography and routine
laboratory investigations were performed for all neonates.
Results:
Urinary NT-proBNP1 was significantly higher in the cardiac and
pulmonary groups than in the control. Moreover, it was significantly higher in
the cardiac than in the pulmonary group. The same results were found again
when NT-proBNP was measured on 5th day of admission.
On comparing urinary NT-proBNP1 & NT-proBNP5 levels of studied
groups, we found that NT-proBNP was significantly lowered on the 5th day in
the pulmonary and control groups. But, its 5th day levels were elevated in the
cardiac group.
Patients who developed heart failure on the 5th day of admission in the
cardiac group had the highest level of urinary NT-proBNP this was significantly higher when compared with NT-proBNP1 and also significantly
higher when compared with patients who didn’t develop heart failure.