Published online May 2, 2005
PEDIATRICS Vol. 115 No. 5 May 2005, pp. 1347-1350 (doi:10.1542/peds.2004-1429)
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Amino-Terminal Pro-Brain-Type Natriuretic Peptide: Heart or Lung Disease in Pediatric Respiratory Distress?

Shlomo Cohen, MD*, Chaim Springer, MD*, Avraham Avital, MD*, Zeev Perles, MD{ddagger}, Azaria J. J. T. Rein, MD{ddagger}, Zvi Argaman, MD§ and Amiram Nir, MD{ddagger}

* Institute of Pulmonology
{ddagger} Pediatric Cardiology Unit, and Department of Pediatrics, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
§ Pediatric Department, Shaare Zedek Medical Center, Jerusalem, Israel

Objectives. The aim of this study was to determine whether plasma levels of amino-terminal pro-brain natriuretic peptide (N-BNP) could differentiate between heart failure and lung disease among infants with acute respiratory distress. In addition, our aim was to determine whether plasma levels of N-BNP could be used to monitor the effects of treatment among infants with heart failure.

Methods. Infants (age range: 1–36 months; median age: 10 months) who presented with respiratory distress underwent physical examination, plasma N-BNP measurement, and echocardiography within 24 hours after admission. Seventeen infants were finally diagnosed with acute heart failure and 18 with acute lung disease. Thirteen healthy infants served as a control group.

Results. Plasma N-BNP levels were significantly higher for the infants with heart failure (median: 18452 pg/mL; range: 5375–99700 pg/mL) than for the infants with lung disease (median: 311 pg/mL; range: 76–1341 pg/mL). Among the infants with heart failure, there was a significant difference in plasma N-BNP levels before and after congestive heart failure treatment.

Conclusion. Among infants with respiratory distress, plasma N-BNP measurements can differentiate between acute heart failure and lung disease and can be used to monitor the effects of treatment for infants with heart failure.

Key Words: amino-terminal pro-brain natriuretic peptide • infants • respiratory distress • congestive heart failure

Abbreviations: BNP, brain natriuretic peptide • N-BNP, amino-terminal pro-brain natriuretic peptide • CHF, congestive heart failure • RD, respiratory distress • RSV, respiratory syncytial virus

Accepted Sep 14, 2004.


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