Open Access

ARTICLE

NT-pro BNP—A marker for worsening respiratory status and mortality in infants and young children with pulmonary hypertension

Shahnawaz M. Amdani¹, Muhammad Umair M. Mian², Ron L. Thomas³, Robert D. Ross⁴

1 Division of Pediatric Cardiology, St. Louis Children’s Hospital, Washington University School of Medicine, St. Louis, Missouri, USA
2 Division of Pediatrics, The Carman and Ann Adams Department of Pediatrics, The Children’s Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan, USA
3 Division of Biostatistics, The Carman and Ann Adams Department of Pediatrics, The Children’s Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan, USA
4 Division of Pediatric Cardiology, The Carman and Ann Adams Department of Pediatrics, The Children’s Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan, USA

* Corresponding Author: Robert D. Ross, Division of Cardiology, Carman and Ann Adams Department of Pediatrics, The Children’s Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI 48201-2119. Email

Congenital Heart Disease 2018, 13(4), 499-505. https://doi.org/10.1111/chd.12601

Abstract

Aim: To evaluate predictors of morbidity and mortality in pediatric patients with pulmonary hypertension (PH), laboratory and echocardiographic measures of PH were analyzed.
Methods: A retrospective review of all infants and children< 2 years of age with PH from January 2011 to August 2016 was conducted. Correlations were determined using Spearman’s rank correlation coefficients. Differences in characteristics between survivors and nonsurvivors were analyzed and Kaplan-Meier survival curves were generated.
Results: Of 56 patients, the majority were extremely premature; of African American ethnicity; and had bronchopulmonary dysplasia. Patients who died were more likely to have underlying congenital heart disease; have a higher increase in the concentration of carbon dioxide in the blood (pCO2) with a corresponding greater mean percentage decrease in pH and percentage rise in NTpro BNP during PH exacerbations; more likely to have been on medications for pulmonary hypertension; and have a higher RVSP/SBP (%) ratio and S/D ratio. There were positive correlations between percentage rise in NT-pro BNP and pCO₂; NT-pro BNP and RVSP/SBP (%) ratio; and RVSP/SBP (%) ratio and S/D ratio.
Conclusions: Infants and young children with pulmonary hypertension have increased morbidity and mortality. NT-pro BNP is a useful biomarker for both respiratory exacerbations and mortality, and RVSP/SBP (%) ratio and S/D ratio are echocardiographic identifiers for increased mortality.

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