Accuracy of Plasma B-Type Natriuretic Peptide to Diagnose Significant Cardiovascular Disease in Children The Better Not Pout Children! Study

Objectives The purpose of this study was to assess the ability of plasma B-type natriuretic peptide (BNP) to diagnose significant cardiovascular disease (CVD) in the pediatric population. Background BNP has been shown to be reliable in detecting ventricular dysfunction and heart failure in adults. Timely and accurate identification of significant pediatric heart disease is important but challenging. A simple blood test could aid the front-line physician in this task. Methods Subjects without a history of heart disease with findings possibly attributable to significant CVD in the acute care setting requiring a cardiology consult were enrolled. Clinicians were blinded to the BNP result, and confirmation of disease was made by cardiology consultation. Results Subjects were divided into a neonatal (n = 42, 0 to 7 days) and older age group (n = 58, > 7 days to 19 years). CVD was present in 74% of neonates and 53% of the older age group. In neonates with disease, median BNP was 526 pg/ml versus 96 pg/ml (p < 0.001) for those without disease. In older children with disease, median BNP was 122 pg/ml versus 22 pg/ml in those without disease (p < 0.001). Subjects with disease from an anatomic defect, a longer hospital stay, or who died had higher BNP. A BNP of 170 pg/ml yielded a sensitivity of 94% and specificity of 73% in the neonatal group and 87% and 70% in the older age group, respectively, using a BNP of 41 pg/ml. Conclusions BNP is a reliable test to diagnose significant structural or functional CVD in children. Optimal cutoff values are different from adult values. (J Am Coll Cardiol 2009;54:1467-75) (C) 2009 by the American College of Cardiology Foundation