B-type natriuretic peptide: perioperative patterns in congenital heart disease.
OBJECTIVE
B-type natriuretic peptide (BNP) has diagnostic, prognostic, and therapeutic roles in adults with heart failure. BNP levels in children undergoing surgical repair of congenital heart disease (CHD) were characterized broadly, and distinguishable subgroup patterns delineated.


METHODS
Prospective, blinded, observational case series.


METHODS
Academic, tertiary care, free-standing pediatric hospital.


METHODS
Children with CHD; controls without cardiopulmonary disease. Interventions. None.


METHODS
Preoperative cardiac medications/doses, CHD lesion types, perioperative BNP levels, intraoperative variables (lengths of surgery, bypass, cross-clamp), postoperative outcomes (lengths of ventilation, hospitalization, open chest; averages of inotropic support, central venous pressure, perfusion, urine output; death, low cardiac output syndrome (LCOS), cardiac arrest; readmission; and discharge medications).


RESULTS
Median BNP levels for 102 neonatal and non-neonatal controls were 27 and 7 pg/mL, respectively. Serial BNP measures from 105 patients undergoing CHD repair demonstrated a median postoperative peak at 12 hours. The median and interquartile postoperative 24-hour average BNP levels for neonates were 1506 (782-3784) pg/mL vs. 286 (169-578) pg/mL for non-neonates (P < 0.001). Postoperative BNP correlated with inotropic requirement, durations of open chest, ventilation, intensive care unit stay, and hospitalization (r = 0.33-0.65, all P < 0.001). Compared with biventricular CHD, Fontan palliations demonstrated lower postoperative BNP (median 150 vs. 306 pg/mL, P < 0.001), a 3-fold higher incidence of LCOS (P < 0.01), and longer length of hospitalization (median 6.0 vs. 4.5 days, P= 0.01).


CONCLUSIONS
Perioperative BNP correlates to severity of illness and lengths of therapy in the CHD population, overall. Substantial variation in BNP across time as well as within and between CHD lesions limits its practical utility as an isolated point-of-care measure. BNP commonly peaks 6-12 hours postoperatively, but the timing and magnitude of BNP elevation demonstrates notable age-dependency, peaking earlier and rising an order of magnitude higher in neonates. In spite of higher clinical acuity, non-neonatal univentricular CHD paradoxically demonstrates lower BNP levels compared with biventricular physiologies.
Niedner
Matthew F
MF
Department of Pediatric Critical Care, Rady Children's Hospital. mniedner@umich.edu
Foley
Jennifer L
JL
Riffenburgh
Robert H
RH
Bichell
David P
DP
Peterson
Bradley M
BM
Rodarte
Alexander
A
D000293:Adolescent; D000367:Age Factors; D015415:Biomarkers; D002140:California; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D006330:Heart Defects, Congenital / Q000097:blood* / Q000401:mortality / Q000601:surgery*; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D019990:Perioperative Care; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D055815:Young Adult
D015415:Biomarkers; D020097:Natriuretic Peptide, Brain