| Congenit Heart Dis. 2010 May-Jun;5(3):243-55. B-type natriuretic peptide: perioperative patterns in congenital heart disease. Niedner MF, Foley JL, Riffenburgh RH, Bichell DP, Peterson BM, Rodarte A. Department of Pediatric Critical Care, Rady Children's Hospital. mniedner@umich.edu Abstract OBJECTIVE: B-type natriuretic peptide (BNP) has diagnostic, prognostic, and therapeutic roles in adults with heart failure. BNP levels in children undergoing surgical repair of congenital heart disease (CHD) were characterized broadly, and distinguishable subgroup patterns delineated. DESIGN: Prospective, blinded, observational case series. SETTING: Academic, tertiary care, free-standing pediatric hospital. PATIENTS: Children with CHD; controls without cardiopulmonary disease. Interventions. None. MEASUREMENTS: Preoperative cardiac medications/doses, CHD lesion types, perioperative BNP levels, intraoperative variables (lengths of surgery, bypass, cross-clamp), postoperative outcomes (lengths of ventilation, hospitalization, open chest; averages of inotropic support, central venous pressure, perfusion, urine output; death, low cardiac output syndrome (LCOS), cardiac arrest; readmission; and discharge medications). RESULTS: Median BNP levels for 102 neonatal and non-neonatal controls were 27 and 7 pg/mL, respectively. Serial BNP measures from 105 patients undergoing CHD repair demonstrated a median postoperative peak at 12 hours. The median and interquartile postoperative 24-hour average BNP levels for neonates were 1506 (782-3784) pg/mL vs. 286 (169-578) pg/mL for non-neonates (P < 0.001). Postoperative BNP correlated with inotropic requirement, durations of open chest, ventilation, intensive care unit stay, and hospitalization (r = 0.33-0.65, all P < 0.001). Compared with biventricular CHD, Fontan palliations demonstrated lower postoperative BNP (median 150 vs. 306 pg/mL, P < 0.001), a 3-fold higher incidence of LCOS (P < 0.01), and longer length of hospitalization (median 6.0 vs. 4.5 days, P= 0.01). CONCLUSIONS: Perioperative BNP correlates to severity of illness and lengths of therapy in the CHD population, overall. Substantial variation in BNP across time as well as within and between CHD lesions limits its practical utility as an isolated point-of-care measure. BNP commonly peaks 6-12 hours postoperatively, but the timing and magnitude of BNP elevation demonstrates notable age-dependency, peaking earlier and rising an order of magnitude higher in neonates. In spite of higher clinical acuity, non-neonatal univentricular CHD paradoxically demonstrates lower BNP levels compared with biventricular physiologies. 结论：总体来说，BNP与先心病的严重程度和治疗时程之间有着密切的联系。但是BNP在不同时间段已经不同的先心病类型中变异程度很大，这使得其作为临床指标的可靠性受到一定影响。BNP通常在术后6到12小时后达到高峰，其发生时段及浓度峰值跟年龄之间有显著关系，在新生儿中其峰值达到时间较早，峰值浓度也较高。尽管其敏感度较高，但是矛盾的是，在单心室生理的先心病中BNP的峰值反倒比双心室生理的要低。 PMID: 20576043 [PubMed - in process] |
