title: Response of cardiac endocrine function to surgery stress is age dependent in neonates and children with congenital heart defects: consequences in diagnostic and prognostic accuracy of brain natriuretic peptide measurement.
abstract: OBJECTIVE
  The aim of this study was to evaluate the diagnostic and prognostic accuracy of brain natriuretic peptide assay in neonates and children undergoing surgery for congenital heart disease.
  
  
  METHODS
  Prospective, observational study.
  
  
  METHODS
  Single center.
  
  
  METHODS
  We enrolled 336 consecutive children (median age, 6 mo [range, 0-37 mo]) undergoing cardiac surgery (87 neonates; age, 7 d [5-12]; median, 25th-75th percentile; 24 infants and children; age, 11 mo [4-60]) and 436 healthy controls.
  
  
  METHODS
  Brain natriuretic peptide was measured preoperatively, on every postoperative day in the ICU, and at discharge. Intubation time was the primary outcome.
  
  
  RESULTS
  Preoperative brain natriuretic peptide values in patients with congenital heart disease were higher than those in controls (p < 0.01). Brain natriuretic peptide had a good diagnostic accuracy in discriminating between patients with congenital heart disease and healthy controls with an area under the curve = 0.918 for neonates and area under the curve = 0.894 for older children. The best cutoff values, calculated by receiver operating characteristic analysis, were different for the two age subgroups with cutoff values of 363.5 ng/L for neonates and 23.5 ng/L for older children. At 24 hours after surgery, although brain natriuretic peptide decreased in neonates (baseline 2723 vs 1290 ng/L, p < 0.001), it increased in children (60 vs 365 ng/L at 24 hours, p < 0.001). Multivariable analysis identified the preoperative level of brain natriuretic peptide in infant/children and the difference in brain natriuretic peptide value (baseline 24 hours) in neonates, as independent predictors of intubation time. Furthermore, body surface area, Aristotle score, and cardiopulmonary bypass time had an independent significant effect on the endpoint in either group.
  
  
  CONCLUSIONS
  Baseline cardiac endocrine function and its response to surgical stress are dependent on age in neonates and children, undergoing cardiac surgery for congenital heart disease. Brain natriuretic peptide shows a good diagnostic and prognostic accuracy in this setting, with different features in either neonates or infants/children subsets.
authors.affiliation: Fondazione Regione Toscana G. Monasterio, Pisa, Italy.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Cantinotti
authors.forename: Simona
authors.initials: S
authors.lastname: Storti
authors.forename: Valentina
authors.initials: V
authors.lastname: Lorenzoni
authors.forename: Bruno
authors.initials: B
authors.lastname: Murzi
authors.forename: Marco
authors.initials: M
authors.lastname: Marotta
authors.forename: Maura
authors.initials: M
authors.lastname: Crocetti
authors.forename: Sabrina
authors.initials: S
authors.lastname: Molinaro
authors.forename: Nadia
authors.initials: N
authors.lastname: Assanta
authors.forename: Leo
authors.initials: L
authors.lastname: Lopez
authors.forename: Aldo
authors.initials: A
authors.lastname: Clerico
mesh_terms: D000367:Age Factors; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D002315:Cardiopulmonary Bypass / Q000706:statistics & numerical data*; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D004452:Echocardiography; D005260:Female; D006330:Heart Defects, Congenital / Q000097:blood / Q000503:physiopathology* / Q000601:surgery; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007442:Intubation, Intratracheal; D007902:Length of Stay; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012016:Reference Values; D013312:Stress, Physiological / Q000502:physiology*
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain