Clinical implication of blood levels of B-type natriuretic peptide in pediatric patients on mechanical circulatory support.
BACKGROUND
B-type natriuretic peptide (BNP) is a marker of heart failure. In adult patients with heart failure, decreased BNP levels after implantation of ventricular assist devices may be indicative of recovery. However, BNP levels among pediatric patients receiving mechanical support are largely unknown.


METHODS
Fifteen pediatric patients with cardiogenic shock who were supported by extracorporeal membrane oxygenation (ECMO) were evaluated. The BNP levels were determined before ECMO initiation, during ECMO support, and after ECMO removal.


RESULTS
All patients had elevated BNP levels before initiation of ECMO (median, 1,430 pg/mL; range, 361 to 5,000 pg/mL). Among the 15 patients, 1 received heart transplantation. Extracorporeal membrane oxygenation was withdrawn in 2 patients, and the other 12 patients were weaned from ECMO. Four patients died after initially successful weaning from ECMO. The BNP levels of the nonsurvivors (median, 3,685 pg/mL; range, 2,494 to 5,000 pg/mL) were higher than those of the survivors (median, 1,127pg/mL; range, 108 to 3,030 pg/mL) on the next few days after ECMO removal (p = 0.016). The BNP levels on the fourth day after removal of ECMO among the survivors (median, 498 pg/mL; range, 108 to 890 pg/mL) were lower than those among the nonsurvivors (median, 3,900 pg/mL; range, 3,230 to 5,000 pg/mL; p = 0.017).


CONCLUSIONS
Among pediatric patients supported with ECMO, the survivors had lower BNP levels than those who did not survive. We suggest that serial blood BNP levels can be potential markers for monitoring pediatric patients on mechanical circulatory support, and the concept merits further study.
Huang
Shu-Chien
SC
Department of Surgery, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan.
Wu
En-Ting
ET
Ko
Wen-Je
WJ
Lai
Ling-Ping
LP
Hsu
Juin
J
Chang
Chung-I
CI
Chiu
Ing-Sh
IS
Wang
Shoei-Shen
SS
Wu
Mei-Hwan
MH
Lin
Fang-Yue
FY
Chen
Yih-Sharng
YS
D015415:Biomarkers; D002303:Cardiac Output, Low / Q000150:complications; D002315:Cardiopulmonary Bypass; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003422:Critical Care; D015199:Extracorporeal Membrane Oxygenation / Q000295:instrumentation; D005260:Female; D006323:Heart Arrest / Q000628:therapy; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011183:Postoperative Complications / Q000097:blood / Q000209:etiology / Q000401:mortality / Q000628:therapy; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012770:Shock, Cardiogenic / Q000097:blood / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D016019:Survival Analysis; D016896:Treatment Outcome
D015415:Biomarkers; D020097:Natriuretic Peptide, Brain