title: B-type natriuretic peptide: prognostic marker in congenital diaphragmatic hernia.
abstract: BACKGROUND
  B-type natriuretic peptide (BNP) has not been evaluated in newborns with congenital diaphragmatic hernia (CDH). We hypothesized that BNP and severity of pulmonary hypertension (PH) would predict clinical outcome in these infants.
  
  
  METHODS
  We measured BNP levels and assessed severity of PH by echocardiography at 1 d and 1 wk of life. Outcome was classified by status at 56 d (or prior discharge): Good (n = 13) if alive on room air and Poor (n = 14) if expired or receiving respiratory support. We estimated area under the curve (AUC) and 95% confidence interval (CI).
  
  
  RESULTS
  BNP levels were higher at 1 d in newborns with Poor outcome (median 220 pg/ml vs. 55 pg/ml, P < 0.01). At 1 wk, there was no significant difference in BNP level (median 547 pg/ml vs. 364 pg/ml, P = 0.70, for Poor and Good outcomes). At 1 d, BNP level predicted outcome (AUC = 0.91, 95% CI = 0.77-1.0), but this relationship dissipated by 1 wk (AUC = 0.55, 95% CI = 0.31-0.79). Severity of PH did not predict outcome at 1 d (AUC = 0.51, 95% CI = 0.27-0.74), but prediction improved at 1 wk (AUC = 0.80, 95% CI = 0.61-0.99).
  
  
  CONCLUSIONS
  BNP is a strong predictor of clinical outcome in newborns with CDH at 1 d of life.
authors.affiliation: Department of Pediatrics, University of California, San Francisco, San Francisco, California.
authors.forename: Martina A
authors.initials: MA
authors.lastname: Steurer
authors.affiliation: Department of Pediatrics, University of California, San Francisco, San Francisco, California.
authors.forename: Anita J
authors.initials: AJ
authors.lastname: Moon-Grady
authors.affiliation: 1] Department of Pediatrics, University of California, San Francisco, San Francisco, California [2] Cardiovascular Research Institute, University of California, San Francisco, San Francisco, California.
authors.forename: Jeff R
authors.initials: JR
authors.lastname: Fineman
authors.affiliation: 1] Department of Pediatrics, University of California, San Francisco, San Francisco, California [2] Cardiovascular Research Institute, University of California, San Francisco, San Francisco, California.
authors.forename: Christine E
authors.initials: CE
authors.lastname: Sun
authors.affiliation: Department of Pediatrics, University of California, San Francisco, San Francisco, California.
authors.forename: Leslie A
authors.initials: LA
authors.lastname: Lusk
authors.affiliation: Department of Pediatrics, University of California, San Francisco, San Francisco, California.
authors.forename: Katherine C
authors.initials: KC
authors.lastname: Wai
authors.affiliation: Department of Pediatrics, University of California, San Francisco, San Francisco, California.
authors.forename: Roberta L
authors.initials: RL
authors.lastname: Keller
mesh_terms: D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D005260:Female; D065630:Hernias, Diaphragmatic, Congenital / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D017052:Hospital Mortality; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging / Q000209:etiology; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D066087:Perinatal Death; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain