B-type natriuretic peptide levels predict outcome after neonatal cardiac surgery

Jong Hau Hsu, Roberta L. Keller, Omar Chikovani, Henry Cheng, Seth A. Hollander, Tom R. Karl, Anthony Azakie, Ian Adatia, Peter Oishi, Jeffrey R. Fineman

Research output: Contribution to journalArticlepeer-review

40 Scopus citations


Objectives: Neonates undergoing cardiac surgery are at high risk for adverse outcomes. B-type natriuretic peptide is used as a biomarker in patients with cardiac disease, but the predictive value of B-type natriuretic peptide after cardiac surgery in neonates has not been evaluated. Therefore, the objective of this study was to determine the predictive value of perioperative B-type natriuretic peptide levels for postoperative outcomes in neonates undergoing cardiac surgery. Methods: Plasma B-type natriuretic peptide determinations were made before and 2, 12, and 24 hours after surgery in 36 consecutive neonates. B-type natriuretic peptide levels and changes in perioperative B-type natriuretic peptide were evaluated as predictors of postoperative outcome. Results: B-type natriuretic peptide levels at 24 hours were lower than preoperative levels (24-h/pre B-type natriuretic peptide ratio < 1) in 29 patients (81%) and higher (24-h/pre B-type natriuretic peptide ratio ≥ 1) in 7 patients (19%). A 24-hour/pre B-type natriuretic peptide level of 1 or greater was associated with an increased incidence of low cardiac output syndrome (100% vs 34%, P = .002) and fewer ventilator-free days (17 ± 13 days vs 26 ± 3 days, P = .002), and predicted the 6-month composite end point of death, an unplanned cardiac operation, or cardiac transplant (57% vs 3%, P = .003). A 24-hour/pre B-type natriuretic peptide level of 1 or greater had a sensitivity of 80% and a specificity of 90% for predicting a poor postoperative outcome (P = .003). Conclusion: In neonates undergoing cardiac surgery, an increase in B-type natriuretic peptide 24 hours after surgery predicts poor postoperative outcome.

Original languageEnglish (US)
Pages (from-to)939-945
Number of pages7
JournalJournal of Thoracic and Cardiovascular Surgery
Issue number4
StatePublished - Oct 2007

Bibliographical note

Funding Information:
This research was supported in part by grants K08 HL086513 (P.O.), K23 HL079922 (R.L.K.), and HL61284 and MO1RR01271 (J.R.F.) from the National Institutes of Health, and a grant from Biosite Diagnostic.


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