• Qian Zhang, Zan Yang Shi, Cheng Han Luo, Li Wang, Shan Shan Zhang, Xin Ru Cheng, Qin Zhang, Qian Ya Xu, Hong Xiang Guo, Xiu Yong Cheng, and Guang Yao Sheng.
• Department of Pediatric, The First Affiliated Hospital of Zhengzhou University, Zhengzhou City, China.
• Pediatr. Pulmonol. 2014 Aug 1;49(8):757-63.

ObjectiveTo evaluate the value of N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels along with spontaneous breathing trial (SBT) in the prediction of ventilator weaning outcome among respiratory distress syndrome (RDS) preterm infants ready to wean.MethodsNT-proBNP along with plasma albumin concentration, serum sodium, serum potassium, and hematocrit were measured immediately before SBT in preterm infants (≤32 weeks) mechanically ventilated due to RDS. Extubation was considered successful if infants remained extubated >48 hr. Either SBT failure or extubation failure was considered weaning failure.ResultsSixty-three of 88 infants passed the SBT and were subsequently extubated. Of these, two (3.2%) cases rapidly developed laryngeal dyspnea imposing reintubation (excluded from analysis). Of the remaining 61 infants, 45 (73.8%) cases had successful extubation, and 16 (26.2%) cases were reintubated. Infants who failed weaning had lower gestational age, birth weight, and plasma albumin concentrations, higher NT-proBNP, doses of surfactant, occurrence of ventilator-associated pneumonia, and occurrence of pulmonary arterial hypertension than those who did not. NT-proBNP was the only independent factor that could predict weaning failure (OR = 1.872; P = 0.044). The ROC-AUC for NT-proBNP to predict weaning failure was 0.977 (95% CI 0.918-0.997; P < 0.001). The cut-off of NT-proBNP level 18,500 pg/ml to predict weaning failure had a positive likelihood ratio of 25.180. The addition of NT-proBNP to SBT in prediction of weaning failure significantly improved the net reclassification improvement (NRI = 0.224; P = 0.034).ConclusionNT-proBNP is an independent factor that could predict weaning failure. Measurement of NT-proBNP prior to SBT may be helpful in promoting successful ventilator weaning along with SBT.© 2013 Wiley Periodicals, Inc.

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