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

Abstract

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.