title: Predictive value of B-type natriuretic peptide level on the postoperative course of infants with congenital heart disease.
abstract: BACKGROUND
  B-type natriuretic peptide (BNP) has been shown to have prognostic value for morbidity and mortality after cardiac surgery. Less is known about its prognostic value in infants.
  
  
  OBJECTIVE
  To investigate the predictive value of BNP levels regarding the severity of the postoperative course in infants undergoing surgical repair of congenital heart disease.
  
  
  METHODS
  We conducted a prospective comparative study. Plasma BNP levels in infants aged 1-12 months with congenital heart disease undergoing complete repair were measured preoperatively and 8, 24 and 48 hours postoperatively. Demographic and clinical data included postoperative inotropic support and lactate level, duration of mechanical ventilation, intensive care unit (ICU) and hospitalization stay.
  
  
  RESULTS
  Cardiac surgery was performed in 19 infants aged 1-12 months. Preoperative BNP level above 170 pg/ml had a positive predictive value of 100% for inotropic score > or = 7.5 at 24 hours (specificity 100%, sensitivity 57%) and 48 hours (specificity 100%, sensitivity 100%), and was associated with longer ICU stay (P = 0.05) and a trend for longer mechanical ventilation (P = 0.12). Similar findings were found for 8 hours postoperative BNP above 1720 pg/ml. BNP level did not correlate with measured fractional shortening.
  
  
  CONCLUSIONS
  In infants undergoing heart surgery, preoperative and 8 hour BNP levels were predictive of inotropic support and longer ICU stay. These findings may have implications for preplanning ICU loads in clinical practice. Further studies with larger samples are needed.
authors.affiliation: Department of Pediatric Intensive Care, Schneider Children's Medical Center of Israel, Petah Tikva, Israel. enahum@clalit.org.il
authors.forename: Elhanan
authors.initials: E
authors.lastname: Nahum
authors.forename: Uri
authors.initials: U
authors.lastname: Pollak
authors.forename: Ovdi
authors.initials: O
authors.lastname: Dagan
authors.forename: Gabriel
authors.initials: G
authors.lastname: Amir
authors.forename: George
authors.initials: G
authors.lastname: Frenkel
authors.forename: Einat
authors.initials: E
authors.lastname: Birk
mesh_terms: D015331:Cohort Studies; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data*; D007902:Length of Stay; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011184:Postoperative Period; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000379:methods*; D012680:Sensitivity and Specificity; D013997:Time Factors
chemical_list: D020097:Natriuretic Peptide, Brain