Abstract
During the last decade, interest in the brain natriuretic peptide (BNP) and N-terminal
probrain natriuretic peptide (NT-proBNP) in the pediatric population has progressively
increased. The aim of this article is to provide an up to date review of evidences
regarding the use of BNP/NT-proBNP in pediatrics, with a particular focus on neonatal
intensive care and congenital heart disease. The potentialities of the BNP have been
demonstrated in multiple settings, particularly: the screening of congenital/acquired
heart disease (CHD) versus pulmonary disease; the evaluation of CHD severity (grade
of heart failure, degree of left-to-right shunts); the management of children undergoing
cardiac surgery; and monitoring premature infants with patent arterial duct. BNP/NT-proBNP
values may be considered an easy and relatively low cost additional diagnostic and
prognostic tool. Interpretation of BNP values in children requires attention to important
factors, including: laboratory methods, the type of cardiac defect, its severity,
and the presence of extracardiac conditions. Of these, the hemodynamic characteristic
of CHD and physiologic variations of BNP values occurring during the first weeks of
life play a major role. The current evidences in favor of BNP use are mainly derived
from single-center, nonrandomized studies, and cost-effectiveness analysis are still
lacking. As such, despite sufficient evidences supporting the diagnostic and prognostic
potentialities of BNP, these findings should be reinforced by multicenter, randomized
studies specifically designed to evaluate outcomes and cost-effectiveness. In addition,
standard consensus documents/guidelines, that are currently lacking, are warranted
for a more systematic use of BNP in the pediatric age.
Keywords
biomarker - natriuretic peptides - BNP - children - neonates - congenital heart disease
