A review of the natriuretic hormone system's diagnostic and therapeutic potential in critically ill children.
OBJECTIVE
To review the natriuretic hormone system and discuss its diagnostic, prognostic, and therapeutic potential in critically ill children.


METHODS
A thorough literature search of MEDLINE was performed using search terms including heart defects, congenital; cardiopulmonary bypass, atrial natriuretic factor; natriuretic peptide, brain; carperitide; nesiritide. Preclinical and clinical investigations and review articles were identified that describe the current understanding of the natriuretic hormone system and its role in the regulation of vascular tone and fluid balance in healthy adults and children and in those with underlying cardiac, pulmonary, and renal disease.


RESULTS
A predictable activation of the natriuretic hormone system occurs in children with congenital heart disease and congestive heart failure. Further study is needed to confirm preliminary reports that measurement of natriuretic hormone levels in critically ill children provides diagnostic and prognostic information, as has been demonstrated in adult cardiac populations. Natriuretic hormone infusions provide favorable hemodynamic changes and symptomatic relief when used in adults with decompensated congestive heart failure, and uncontrolled case series suggest that similar benefits may exist in children. The biological activity of the natriuretic hormone system may be decreased following pediatric cardiopulmonary bypass, and additional studies are needed to determine whether natriuretic hormone infusions provide clinical benefit in the postoperative period. Preliminary reports suggest that natriuretic hormone infusions cause physiologic improvements in adults with acute lung injury and asthma but not in those with acute renal failure.


CONCLUSIONS
Although important perturbations of the natriuretic hormone system occur in critically ill infants and children, further investigation is needed before the measurement of natriuretic peptides and the use of natriuretic hormone infusions are incorporated into routine practice.
Costello
John M
JM
Division of Cardiac Intensive Care, Department of Cardiology, Children's Hospital Boston and Harvard Medical School, Boston, MA, USA.
Goodman
Denise M
DM
Green
Thomas P
TP
D000293:Adolescent; D009320:Atrial Natriuretic Factor / Q000378:metabolism / Q000494:pharmacology / Q000502:physiology / Q000627:therapeutic use; D015415:Biomarkers / Q000378:metabolism; D002315:Cardiopulmonary Bypass; D002648:Child; D002675:Child, Preschool; D003422:Critical Care; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery; D006333:Heart Failure / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D045283:Natriuretic Agents / Q000378:metabolism / Q000494:pharmacology / Q000502:physiology / Q000627:therapeutic use; D020097:Natriuretic Peptide, Brain / Q000378:metabolism / Q000494:pharmacology / Q000502:physiology / Q000627:therapeutic use
D015415:Biomarkers; D045283:Natriuretic Agents; D020097:Natriuretic Peptide, Brain; D009320:Atrial Natriuretic Factor