title: Brain-type natriuretic peptide levels correlate with pulmonary hypertension and requirement for extracorporeal membrane oxygenation in congenital diaphragmatic hernia.
abstract: OBJECTIVE
  B-type natriuretic peptide (BNP), an established biomarker of ventricular pressure overload, is used in the assessment of children with pulmonary hypertension (PH). PH is commonly observed in congenital diaphragmatic hernia (CDH). However, the use of BNP levels to guide treatment in this patient population has not been well defined. In this study, we investigate BNP levels in a large cohort of CDH patients treated at a single institution.
  
  
  METHODS
  We retrospectively reviewed charts of all CDH patients enrolled in our pulmonary hypoplasia program from 2004-2013. PH was assessed by echocardiography using defined criteria, and patients were further stratified into the following cohorts: no PH, short-term PH (requiring nitric oxide but no additional vasodilatory therapy), long-term PH (requiring continued vasodilatory therapy post-discharge), and ECMO (requiring ECMO therapy).
  
  
  RESULTS
  A total of 132 patients were studied. BNP levels were significantly increased in patients with PH compared to patients with normal pulmonary pressures (P<0.01). BNP levels were not significantly different between the ST-PH, LT-PH, and ECMO cohorts, but all levels in all three cohorts were significantly increased compared to patients who did not develop PH.
  
  
  CONCLUSIONS
  Our findings indicate that plasma BNP levels correlate with pulmonary hypertension as well as the requirement for ECMO in CDH patients. Monitoring of serial BNP levels may provide a useful prognostic tool in the management of CDH.
authors: The Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia PA, 19104.
authors: Emily A
authors: EA
authors: Partridge
authors: The Division of Cardiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia PA, 19104.
authors: Brian D
authors: BD
authors: Hanna
authors: The Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia PA, 19104.
authors: Natalie E
authors: NE
authors: Rintoul
authors: The Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia PA, 19104.
authors: Lisa
authors: L
authors: Herkert
authors: The Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia PA, 19104.
authors: Alan W
authors: AW
authors: Flake
authors: The Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia PA, 19104.
authors: N Scott
authors: NS
authors: Adzick
authors: The Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia PA, 19104.
authors: Holly L
authors: HL
authors: Hedrick
authors: The Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia PA, 19104. Electronic address: peranteauw@email.chop.edu.
authors: William H
authors: WH
authors: Peranteau
mesh_terms: D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D065630:Hernias, Diaphragmatic, Congenital / Q000097:blood / Q000150:complications / Q000601:surgery*; D059685:Herniorrhaphy; D006801:Humans; D006976:Hypertension, Pulmonary / Q000097:blood / Q000150:complications* / Q000503:physiopathology; D007231:Infant, Newborn; D008297:Male; D016343:Monitoring, Intraoperative; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D012189:Retrospective Studies; D017725:Ventricular Pressure
chemical_list: D020097:Natriuretic Peptide, Brain
keywords: Brain-type natriuretic peptide; Congenital diaphragmatic hernia; Extracorporeal membrane oxygenate; Pulmonary hypertension