Plasma concentrations of N-terminal pro-brain natriuretic peptide in control children from the neonatal to adolescent period and in children with congestive heart failure.
OBJECTIVE
To determine plasma levels of N-terminal pro-brain natriuretic peptide (N-BNP) in control children to establish a normal age-dependent range from the neonatal period to adulthood. In addition, plasma concentrations of N-BNP were measured in children with congestive heart failure (CHF) and correlated with ejection fraction and clinical symptoms of heart failure.


METHODS
For establishing a normal age-dependent range of plasma N-BNP, venous blood samples were taken in 133 control patients from the neonatal period to adulthood (10 days-32 years) and in 31 children with CHF. Plasma N-BNP levels were determined by an enzyme immunoassay. In children (1 month-14 years) with CHF, plasma N-BNP levels were correlated to ejection fraction measured by echocardiography and clinical symptoms of heart failure using the Ross Score.


RESULTS
N-BNP levels in control children, adolescents, and adults did not show a significant age-related difference. In control children, the normal range was established between 150 (10th percentile) and 430 fmol/mL (90th percentile). Mean plasma N-BNP in control children was 311 fmol/mL (range: 74-654 fmol/mL). In 31 children with CHF, the plasma N-BNP levels were significantly higher (mean: 846; range: 219-2718) than in control children. N-BNP levels showed a negative correlation with the ejection fraction (r = -0.53) and a positive correlation with the clinical heart failure score (r = 0.74).


CONCLUSIONS
Plasma N-BNP levels reflect the severity of symptoms of heart failure and the impairment of cardiac function in children with CHF. In the future, determination of plasma N-BNP levels may be used as a helpful adjunct to monitor the effect of various treatments for CHF in children.
Mir
Thomas S
TS
Klinik und Poliklinik für Kinder und Jugendmedizin, Abteilung für Kinderkardiologie, Universitätsklinikum Eppendorf, Hamburg, Germany. mir@uke.uni-hamburg.de
Marohn
Sönke
S
Läer
Stephanie
S
Eiselt
Michele
M
Grollmus
Oswin
O
Weil
Jochen
J
D000293:Adolescent; D000328:Adult; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D004077:Digoxin / Q000627:therapeutic use; D004232:Diuretics / Q000627:therapeutic use; D004452:Echocardiography; D006333:Heart Failure / Q000097:blood* / Q000175:diagnosis / Q000188:drug therapy; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D020097:Natriuretic Peptide, Brain; D009419:Nerve Tissue Proteins / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011498:Protein Precursors / Q000097:blood*; D012016:Reference Values; D012720:Severity of Illness Index; D013318:Stroke Volume
D000806:Angiotensin-Converting Enzyme Inhibitors; D004232:Diuretics; D009419:Nerve Tissue Proteins; D010446:Peptide Fragments; D011498:Protein Precursors; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D004077:Digoxin