Supplementary Material for: Diagnostic accuracy of urinary NT-proBNP for hemodynamically significant PDA in preterm infants

BACKGROUND: Echocardiography is the gold standard for the diagnosis hemodynamically significant-patent ductus arteriosus (hs-PDA). It requires trained personnel, and is not readily available. Urinary biomarkers can be used as an adjunct. OBJECTIVE: To systematically review the diagnostic accuracy of urinary NT-proBNP for hsPDA in preterm neonates. METHODS: We included studies that evaluated urinary NT-proBNP and urinary NT-proBNP/Creatinine ratio (index tests) in preterm neonates with hsPDA (participants) in comparison with echocardiogram (reference standard). Methodological quality and certainty of evidence were assessed using Quality Assessment of Diagnostic-Accuracy Studies (QUADAS-2) and Grading of Recommendations Assessment, Development and Evaluation (GRADE), respectively. RESULTS: Low quality of evidence suggests that Urinary NT-proBNP has modest sensitivity and specificity for the diagnosis of a hsPDA, with variation in accuracy based on assay and patient characteristics. CONCLUSION: Urinary NT-proBNP assays must be locally validated for specific patient populations and further studies to support its use must be performed.