BNP in children with congenital cardiac disease: is there now sufficient evidence for its routine use?

Area of Science:

• Biomarkers in Pediatric Cardiology
• Congenital Heart Disease Management
• Cardiac Surgery Outcomes

Background:

• Growing interest in brain natriuretic peptide (BNP) and N-terminal pro-brain natriuretic peptide (NT-proBNP) for managing pediatric congenital heart disease (CHD).
• Lack of current guidelines for the routine use of BNP/NT-proBNP in this population.
• BNP/NT-proBNP levels in children with CHD are influenced by age, assay methods, and specific hemodynamic factors.

Purpose of the Study:

• To review current data on the use of BNP/NT-proBNP in evaluating and surgically treating children with CHD.
• To highlight the established accuracy of BNP/NT-proBNP as supplemental markers in CHD screening, diagnosis, management, and follow-up.
• To emphasize their demonstrated role as prognostic indicators in pediatric cardiac surgery and patient follow-up.

Main Methods:

• Review of existing literature on BNP/NT-proBNP in pediatric CHD.
• Analysis of data regarding the variability of BNP/NT-proBNP levels based on patient and disease characteristics.
• Synthesis of evidence on the prognostic utility of BNP/NT-proBNP in pediatric cardiac surgery.

Main Results:

• BNP/NT-proBNP accuracy as supplemental markers in CHD care is established.
• Significant prognostic value demonstrated in pediatric cardiac surgery and subsequent follow-up.
• Most data comes from retrospective, single-center studies, indicating a need for higher-level evidence.

Conclusions:

• Prospective, randomized clinical trials are essential to evaluate the clinical utility and cost-effectiveness of routine BNP/NT-proBNP use in CHD.
• Results from such trials will aid in developing guidelines and expert consensus for BNP/NT-proBNP application in CHD.
• Point-of-care testing with less invasive sampling may increase BNP assay use, especially in neonates and infants, potentially aiding CHD screening programs.