title: B-type natriuretic peptide levels predict outcome after neonatal cardiac surgery.
abstract: OBJECTIVE
  Neonates undergoing cardiac surgery are at high risk for adverse outcomes. B-type natriuretic peptide is used as a biomarker in patients with cardiac disease, but the predictive value of B-type natriuretic peptide after cardiac surgery in neonates has not been evaluated. Therefore, the objective of this study was to determine the predictive value of perioperative B-type natriuretic peptide levels for postoperative outcomes in neonates undergoing cardiac surgery.
  
  
  METHODS
  Plasma B-type natriuretic peptide determinations were made before and 2, 12, and 24 hours after surgery in 36 consecutive neonates. B-type natriuretic peptide levels and changes in perioperative B-type natriuretic peptide were evaluated as predictors of postoperative outcome.
  
  
  RESULTS
  B-type natriuretic peptide levels at 24 hours were lower than preoperative levels (24-h/pre B-type natriuretic peptide ratio < 1) in 29 patients (81%) and higher (24-h/pre B-type natriuretic peptide ratio > or = 1) in 7 patients (19%). A 24-hour/pre B-type natriuretic peptide level of 1 or greater was associated with an increased incidence of low cardiac output syndrome (100% vs 34%, P = .002) and fewer ventilator-free days (17 +/- 13 days vs 26 +/- 3 days, P = .002), and predicted the 6-month composite end point of death, an unplanned cardiac operation, or cardiac transplant (57% vs 3%, P = .003). A 24-hour/pre B-type natriuretic peptide level of 1 or greater had a sensitivity of 80% and a specificity of 90% for predicting a poor postoperative outcome (P = .003).
  
  
  CONCLUSIONS
  In neonates undergoing cardiac surgery, an increase in B-type natriuretic peptide 24 hours after surgery predicts poor postoperative outcome.
authors: Department of Pediatrics, University of California, San Francisco, Calif, USA.
authors: Jong-Hau
authors: JH
authors: Hsu
authors: Roberta L
authors: RL
authors: Keller
authors: Omar
authors: O
authors: Chikovani
authors: Henry
authors: H
authors: Cheng
authors: Seth A
authors: SA
authors: Hollander
authors: Tom R
authors: TR
authors: Karl
authors: Anthony
authors: A
authors: Azakie
authors: Ian
authors: I
authors: Adatia
authors: Peter
authors: P
authors: Oishi
authors: Jeffrey R
authors: JR
authors: Fineman
mesh_terms: D000704:Analysis of Variance; D015415:Biomarkers / Q000097:blood; D005260:Female; D006330:Heart Defects, Congenital / Q000097:blood / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric; D013997:Time Factors
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain