Time course and prognostic value of plasma B-type natriuretic peptide concentration in neonates undergoing the arterial switch operation.
BACKGROUND
Plasma B-type natriuretic peptide (BNP) can predict postoperative complications after cardiac surgery in adults. Our aim was to investigate BNP kinetics and prognostic value in neonates undergoing the arterial switch operation (ASO) for transposition of the great arteries (TGA).


METHODS
We measured BNP concentrations in 30 neonates before, immediately after, and 6, 12, 24, and 48 h after ASO for TGA. Complicated postoperative evolution was defined as patients requiring mechanical ventilation or presenting low cardiac output syndrome for more than 72 h. We studied the ability of postoperative BNP concentrations to predict complicated evolution.


RESULTS
Intubation duration, inotropic support duration, and intensive care unit stay were 68 (48-121) h, 78 (69-141) h, and 96 (76-149) h respectively. Patients with complicated evolution had higher 6 and 12-h BNP concentrations than patients with simple evolution (459 (210-897) vs 137 (67-248) ng/L and 547 (193-868) vs 185 (79-354) ng/L respectively; P < 0.05) and had longer intubation, inotropic support, and intensive care unit stay (96 (70-190) vs 50 (48-66) h, 100 (83-190) vs 70 (59-72) h, and 120 (90-240) vs 84 (72-96) h, P < 0.05). A 6-h BNP concentration >160 ng/L was able to predict complicated evolution with a sensitivity of 93% and a specificity of 67%.


CONCLUSIONS
In neonates, BNP concentrations can predict adverse outcome in the postoperative period after ASO for TGA. This marker has potential clinical applications.
Cannesson
Maxime
M
Department of Anesthesiology and Intensive Care, Hospices Civils de Lyon, Louis Pradel Hospital and Claude Bernard Lyon 1 University, Lyon, France. maxime_cannesson@hotmail.com
Bionda
Clara
C
Gostoli
Bruno
B
Raisky
Olivier
O
di Filippo
Sylvie
S
Bompard
Dominique
D
Védrinne
Catherine
C
Rousson
Robert
R
Ninet
Jean
J
Neidecker
Jean
J
Lehot
Jean-Jacques
JJ
D015415:Biomarkers / Q000097:blood; D013504:Cardiovascular Surgical Procedures; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011183:Postoperative Complications / Q000097:blood* / Q000175:diagnosis*; D011379:Prognosis; D011446:Prospective Studies; D013997:Time Factors
D015415:Biomarkers; D020097:Natriuretic Peptide, Brain