Publication:

Point of care estimation of B type natriuretic peptide levels in pediatric patients as a marker of cardiac disease

Background Early recognition of heart disease in children can be challenging, because children often have a limited repertoire of presenting signs and symptoms. Primary purpose of our study was to compare the levels of BNP in cardiac and non-cardiac pediatric patients admitted in PICU.

Methods The study was conducted prospectively on 45 patients admitted in PICU. The i-STAT POC device (Abbott, East Windsor, NJ) was used for BNP measurement. Patients aging 1 month to 12 years, were enrolled in three cohorts: 1) Cardiac cohort, consisting of patients presenting with features of heart failure, 2) non-cardiac patients admitted in PICU with respiratory distress, 3) Critically sick, non-cardiac patients (PELOD score >20) without respiratory distress.

Results Mean BNP levels in cardiac cohort were 2273 (±1302) pg/ml, which were significantly higher than those observed in respiratory cohort (9655±1223 pg/ml) and other critical illness group (102±168). The area under the ROC curve for BNP was 0.956 and at a value of 837 pg/ml, BNP has a sensitivity of 93.3 and a specificity of 93% to correctly identify CHF in cardiac patients.

Conclusions We concluded that BNP levels are significantly higher in cardiac patients and point of care BNP estimation can easily distinguish between cardiac and non-cardiac patients. We also found that though BNP is raised in respiratory illness as well, levels are not very high as compared to cardiac patients.