Normal values of B type natriuretic peptide in infants, children, and adolescents

Koch, Andreas

doi:10.1136/heart.89.8.875

Cited by 249 publications

(219 citation statements)

References 30 publications

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“…N values in previous studies have been far too small to reliably define reference intervals for males and females at each age group [8][9][10][11][12][13]. Our data differs from that reported by Rauh et al [13] and Koch et al [26]. While both these papers show higher values for BNP and/or NT-proBNP in neonates and agree with our findings in this regard, their values appear to decline fairly rapidly with increasing age.…”

Section: Discussionsupporting

confidence: 65%

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Pediatric brain natriuretic peptide and N-terminal pro-brain natriuretic peptide reference intervals

Soldin

Boyajian

et al. 2006

Clinica Chimica Acta

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Background-Brain natriuretic peptide (BNP) and N-terminal pro-brain natriuretic peptide (NTproBNP) have been shown to be useful biomarkers for the diagnosis of heart failure. Pediatric reference intervals for these analytes have been reported in part. Previous studies lack large numbers in each group, have not covered all age ranges and have not compared results for BNP with NT-proBNP in simultaneously drawn samples.Methods-We measured BNP in whole blood using the Biosite Triage point-of-care method and plasma NT-proBNP using the Dade RxL Dimension. We assessed between and within-day precision of both methods and after removing outliers employed the Hoffmann approach to calculate pediatric reference intervals over the age range of 0-21 y. We also compared the 2 methods on simultaneously drawn samples.Results-Reference intervals revealed approximately 20-fold higher 97.5th percentiles for neonates than for children >3 y of age. 97.5th percentiles decreased significantly over the first 3 years of life. As shown by others, the CVs for the automated Dade RxL platform were somewhat lower than those for the POCT method. BNP and NT-proBNP correlated well in simultaneously drawn samples (r =0.947).Discussion-Reference intervals for BNP and NT-proBNP are far higher in neonates and infants than in children older than three years of age. The reasons for this are unknown but resemble the elevated CK-MBs and troponins also found in neonates, although the 97.5th percentiles for these latter 2 cardiac markers decrease more rapidly to values found in older children by 6 months of age.

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Section: Discussionsupporting

confidence: 65%

“…Another possible reason is the possibility of peptide clearance by the placenta which ends at birth [27]. A close examination of their [13,26] data reveals that the number of male and female children studied at any one age group are very small with numbers of 1 to 6. This would question the reliability of their reference intervals.…”

Section: Discussionmentioning

confidence: 99%

Pediatric brain natriuretic peptide and N-terminal pro-brain natriuretic peptide reference intervals

Soldin

Boyajian

et al. 2006

Clinica Chimica Acta

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“…19 Previous studies showed that plasma concentration of BNP is high in the first few days after birth due to changes in circulatory volume leading to increased ventricular volume and pressure load. 27,28 In this study, it is suggested that the peak of plasma NT-proBNP level was in the first 48 h of life and then declined rapidly within the first 7 days, except for those with HsPDA in which NT-proBNP levels were approximately 5-8 times higher. Our findings suggest that physiological changes of NT-proBNP follow the pattern of BNP changes.…”

Section: Discussionmentioning

confidence: 68%

“…[20][21][22][23] Studies in adults have shown that NT-proBNP is a more sensitive and more specific marker for ventricular dysfunction than the biologically active BNP. 24,25 Previous studies in healthy full-term infants showed that the plasma BNP level rapidly rises after birth, reaching its peak at day 2-3 of life [26][27][28] and a high plasma BNP level correlates with HsPDA. A decline of BNP level is noted after PDA is closed by indomethacin.…”

Section: Introductionmentioning

confidence: 99%

N-terminal probrain natriuretic peptide and patent ductus arteriosus in preterm infants

Nuntnarumit

Khositseth

2008

J Perinatol

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Objective: To determine whether plasma N-terminal probrain natriuretic peptide (NT-proBNP) in premature infants could identify hemodynamically significant patent ductus arteriosus (HsPDA) and to determine the correlation between serial plasma NT-proBNP and echocardiographic assessment of ductal shunting.Study Design: An observational study involving 35 preterm infants who underwent echocardiographic assessment for PDA on day 2, 4 and 7 of life with simultaneous blood sampling for determination of NT-proBNP concentrations. HsPDA was diagnosed by left-to-right ductal shunt on color Doppler, measuring diameter >1.5 mm on two-dimensional echocardiography plus X2 clinical features of PDA.Result: Plasma NT-proNBP levels on day 2 in the HsPDA group (n ¼ 12) were significantly higher than in non-HsPDA group (n ¼ 23) with a median of 16 353 pg ml À1 (interquartile range (IQR), 12 360-33 459; range, 10 316-104 998) vs 3914 pg ml À1 (IQR, 2601-5782; range, 1535-19 516) (P<0.001), respectively. Eight infants (67%) in the HsPDA group responded to an initial course of indomethacin or ibuprofen and their NT-proBNP levels significantly decreased within 48 h after treatment compared with non-responders (P ¼ 0.007). NT-proBNP concentrations were significantly correlated with left atrial to aortic root ratio. A cut-off NT-proBNP on day 2 of 10 180 pg ml À1 offered the best predictive values for HsPDA with a sensitivity of 100% and a specificity of 91%.Conclusion: Plasma NT-proBNP on day 2 was found as a sensitive marker for predicting HsPDA in preterm infants. Successful closure of PDA was also correspondent with the decline in plasma NT-proBNP. Journal of Perinatology (2009) 29, 137-142; doi:10.1038/jp.2008 published online 20 November 2008 Keywords: preterm infant; patent ductus arteriosus; NT-proBNP Introduction It is of vital importance to recognize and properly treat hemodynamically significant patent ductus arteriosus (HsPDA) in preterm infants. PDA has been reported to be associated with morbidities in preterm infants as a result of ductal steal from systemic circulation, for example, pulmonary congestion, pulmonary hemorrhage, bronchopulmonary dysplasia, intraventricular hemorrhage and necrotizing enterocolitis. [1][2][3][4] Strategies for PDA closure involve prophylactic treatment, presymptomatic treatment for non-HsPDA, and treatment for HsPDA. 5,6 Although prophylactic treatment with indomethacin reduces incidence of PDA and severe intraventricular hemorrhage in preterm infants, 7,8 there are no differences in mortality and long-term neurodevelopment. 9,10 Recent studies have shown that only one-third of very low birth weight infants develops significant PDA. 10,11 Therefore, a number of infants, whose PDA would otherwise close spontaneously, will be exposed to the treatment unnecessarily if prophylaxis strategy is used. Clinical assessment for the diagnosis of PDA has been shown to be specific, but not sensitive. [12][13][14] Echocardiography is used to detect PDA and to assess the degree of shunting through vario...

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“…According to age-and sex-specific reference values [11,12], BNP was increased in only 13/67 patients.…”

Section: Resultsmentioning

confidence: 92%

B‐type natriuretic peptide levels in patients with functionally univentricular hearts after total cavopulmonary connection

Koch

Zink

Singer

et al. 2008

European J of Heart Fail

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Aims: To assess plasma B-type natriuretic peptide (BNP) levels in patients with univentricular hearts late after volume unloading by total cavopulmonary connection (TCPC). Methods: Plasma BNP was measured by sandwich immunoassay in 67 patients after a modified Fontan procedure. BNP levels were compared with age and sex-specific normal values, clinical and echocardiographic data, and results of exercise testing. Results: BNP had a wide range of 5-290 pg/ml, but was normal in 81% of patients, and median BNP was only 13 pg/ml. There was no difference between males and females, between patients with left or right ventricular morphology, and no correlation was found between BNP and age, post-operative follow-up period, maximum exercise capability, peak oxygen uptake, or blood oxygen saturation. New York Heart Association class I patients had lower BNP than class II patients (p = 0.04). Plasma BNP concentration was positively correlated to the number of specific sequelae (r = 0.59, p b 0.001), and to severity of atrioventricular regurgitation (r = 0.38, p = 0.002). 5/13 patients with elevated BNP died during follow-up. Conclusion: BNP plasma concentration was normal in the majority of patients up to 15 years after TCPC. Elevated and increasing BNP levels were associated with increased morbidity and late mortality.

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Normal values of B type natriuretic peptide in infants, children, and adolescents

Cited by 249 publications

References 30 publications

Pediatric brain natriuretic peptide and N-terminal pro-brain natriuretic peptide reference intervals

Pediatric brain natriuretic peptide and N-terminal pro-brain natriuretic peptide reference intervals

N-terminal probrain natriuretic peptide and patent ductus arteriosus in preterm infants

B‐type natriuretic peptide levels in patients with functionally univentricular hearts after total cavopulmonary connection

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