Circulating cardiovascular biomarkers can accurately detect CHD in newborns: JAMA
Sweden: NT-proBNP assay using minimal DBS samples can help in accurate and timely detection of congenital heart disease (CHD) in newborns, suggests a recent study in the journal JAMA Network Open. This will aid in discriminating well between newborns with CHD and healthy newborns.
CHD is the most common congenital malformation in humans affecting about 1 in 125 newborns, causing substantial mortality and morbidity rates worldwide. Circulating cardiovascular biomarkers could potentially improve the early detection of CHD, even in asymptomatic newborns. Keeping this in mind, Henning Clausen, University Teaching Hospital Ryhov, Jönköping, Sweden, and colleagues assessed the performance of dried blood spot (DBS) test for measuring e cardiovascular biomarker amino terminal fragment of the prohormone brain-type natriuretic peptide (NT-proBNP) levels in newborns. Further, they also compared DBS with standard EDTA analysis in control newborns during the first week of life.
The diagnostic study, conducted in southern Sweden, prospectively enrolled healthy, term neonates born between July 1, 2018, and May 31, 2019. They were compared against retrospectively identified newborns with CHD born between September 1, 2003, and September 30, 2019. It excluded neonates who required inpatient treatment beyond the standard postnatal care. They used the new DBS test for NT-proBNP quantification in newborns that used 3 μL of blood vs the current screening standard.
Performance of the new test and when combined with pulse oximetry screening was measured by receiver operating characteristic curve analysis. Performance of the new test and EDTA screening was compared using Pearson linear correlation analysis.
The DBS samples of 115 neonates (81 control newborns and 34 newborns with CHD, of whom 55% were boys) were analyzed.
Key findings of the study include:
- The new NT-proBNP test alone identified 71% of all CHD cases and 68% of critical CHD cases as soon as 2 days after birth.
- Detection of any CHD type improved to 82% newborns and detection of critical CHD improved to 89% newborns when combined pulse oximetry screening and NT-proBNP test results were used.
- Performance of the NT-proBNP test was excellent when control newborns were matched to newborns with CHD born between July 1, 2018, and May 31, 2019 (area under the curve, 0.96; SE, 0.027).
"This study found that NT-proBNP assay using minimal DBS samples appears to be timely and accurate in detecting CHD in newborns and to discriminate well between healthy newborns and newborns with various types of CHD," the authors wrote.
"This finding warrants further studies in larger cohorts and highlights the potential of NT-proBNP to improve neonatal CHD screening," they concluded.
The study, "Evaluation of Circulating Cardiovascular Biomarker Levels for Early Detection of Congenital Heart Disease in Newborns in Sweden," is published in the journal JAMA Network Open.
DOI: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/10.1001/jamanetworkopen.2020.27561
