title: Diagnosing heart failure in children with congenital heart disease and respiratory syncytial virus bronchiolitis.
abstract: OBJECTIVE
  The objective of this study is to examine if the B-type natriuretic peptide (BNP) can be used in diagnosing heart failure (HF) in children with congenital heart disease (CHD) who present to the emergency department (ED) with acute bronchiolitis.
  
  
  METHODS
  A prospective cohort single-group study of children with CHD and respiratory syncytial virus bronchiolitis was conducted in a pediatric ED. The reference standard for the presence of HF was the clinical and echocardiographic assessment of a pediatric cardiologist blinded to the BNP test results.
  
  
  RESULTS
  Eighteen cases were diagnosed, 7 (39%) had acute HF and 11 (61%) did not have acute HF. Patients with HF had a higher level of BNP compared with patients who did not have HF (783 pg/mL [interquartile range, 70-1345] vs 59 pg/mL [interquartile range, 23-90]; P<.013). A BNP level of 95 pg/mL was the optimal cutoff point, having a sensitivity of 0.71 (95% confidence interval, 0.29-0.96) and a specificity of 0.91 (95% confidence interval, 0.58-0.99).
  
  
  CONCLUSIONS
  The results of this small study suggest that the BNP test can be useful to ascertain the presence of HF in children with CHD who present to the ED with respiratory syncytial virus bronchiolitis.
authors.affiliation: Pediatric Emergency Department, Rambam Health Care Campus, Haifa Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
authors.forename: Nir
authors.initials: N
authors.lastname: Samuel
authors.affiliation: Department of Pediatrics B, Rambam Health Care Campus, Haifa Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
authors.forename: Tova
authors.initials: T
authors.lastname: Hershkovitz
authors.affiliation: Department of Pediatrics B, Rambam Health Care Campus, Haifa Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
authors.forename: Riva
authors.initials: R
authors.lastname: Brik
authors.affiliation: Pediatric Cardiology and Adults with Congenital Heart Disease, Rambam Health Care Campus, Haifa, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
authors.forename: Avraham
authors.initials: A
authors.lastname: Lorber
authors.affiliation: Pediatric Emergency Department, Rambam Health Care Campus, Haifa Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel. Electronic address: itai@pem-database.org.
authors.forename: Itai
authors.initials: I
authors.lastname: Shavit
mesh_terms: D015415:Biomarkers / Q000097:blood; D001990:Bronchiolitis, Viral / Q000150:complications*; D005260:Female; D006330:Heart Defects, Congenital / Q000150:complications*; D006333:Heart Failure / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D007223:Infant; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011446:Prospective Studies; D018357:Respiratory Syncytial Virus Infections / Q000150:complications*; D018113:Respiratory Syncytial Virus, Human; D012680:Sensitivity and Specificity
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain