Usefulness of amino terminal pro-B-type natriuretic peptide in evaluating children with cardiac failure.

Background: The plasma levels of amino terminal pro-B type natriuretic peptide (NT-proBNP) have been found to be useful in evaluating children with heart failure in developed countries where the cause is mainly structural heart lesions. There is paucity of similar studies from developing countries where the causes are mostly of infectious origin. This article is aim to evaluate the relationship between plasma NT-proBNP levels and the severity, outcome and duration of admission of children with heart failure.

Methods: The subjects were children presenting to the children's emergency room (CHER) diagnosed with heart failure based on the modified Ross criteria. The controls were age matched well children recruited from follow up clinics. Information on bio-data and socio-demographics was collected while blood was obtained for plasma NT-proBNP measurement. Data analysis was done with SPSS.

Results: One hundred and twenty six subjects and same number of controls aged 2 months to 13 years were recruited. The mean plasma NT-proBNP in the subjects was 1,137.10±1,243.78 ng/L and in controls, 578.00±665.08 ng/L (t=5.669, P<0.001). Subjects with severe heart failure had a statistically significantly higher mean plasma NT-proBNP than those with mild or moderate categories (P<0.001). A plasma NT-proBNP of 903.15 ng/L had a 73.3% sensitivity and 72.1% specificity for identifying severe heart failure using receiver operating curve (ROC) analysis (95% CI, 0.659-0.912, P<0.001).

Conclusions: Children with heart failure had significantly higher mean NT-proBNP value than controls and the value was highest in those with severe form of heart failure compared to those with moderate or mild categories. Plasma NT-proBNP should be determined for children presenting with clinically diagnosed heart failure to identify those with severe heart failure and institute prompt treatment.