B-type Natriuretic Peptide in the Non-Cardiac Pediatric Patient
Condition: Heart Diseases
MeSH terms: Heart Diseases
Study type: Observational

Summary: 
      B-type Natriuretic Peptide (BNP) is a hormone that is made by the pumping chambers of the
      heart. The BNP level can be measured by a blood test and is used as a marker for heart
      problems in adults. Deciding if a child has a heart problem or a lung problem can be very
      difficult, especially in infants. Several studies have demonstrated that BNP levels are
      elevated when children have heart disease.

      The overall goal of the study is to be able to prove that obtaining BNP levels in pediatric
      patients can be used to identify heart problems. We already know that kids with heart
      problems have high BNP levels (>200pg/ml). We need to prove that children who come to the
      Emergency Department for non-cardiac problems still have normal BNP levels (<100pg/ml,
      slightly higher in the newborn population). This will be done by comparing BNP levels with
      the final diagnosis made by the ED physician.
    

Detailed description: 
      Introduction At Children's Healthcare of Atlanta, thousands of children are seen in the
      Emergency Department (ED) each year for evaluation and treatment. Deciding if a child has a
      cardiac or pulmonary problem can be very difficult, especially in infants. Early recognition
      of cardiac disease can significantly impact the physician's ability to provide appropriate
      treatment, make necessary interventions, and affect patient outcome. An accurate laboratory
      marker of cardiac disease for pediatric Emergency Medicine does not exist. B-Type Natriuretic
      Peptide (BNP) is a hormone produced by the ventricular myocardium (heart muscle) in response
      to increased myocardial demands. It has been used extensively in the adult population to
      evaluate patients for heart disease, and has been demonstrated to be very accurate in the
      differentiation of heart disease from lung disease in the adult Emergency Department.

      There is increasing experience with BNP in pediatrics for the evaluation of heart disease,
      primarily in patients with congenital heart disease. The normal BNP level is less than 100
      pg/ml, slightly higher in neonates. Patients who present to the ED and are diagnosed with
      heart disease are often admitted to the Cardiac Intensive Care Unit (CICU) for further
      management and stabilization. Part of the initial evaluation is a BNP level. These patients
      usually have marked elevation of the BNP levels in the 2000-5000 pg/ml range upon admission.
      The level varies with the type and severity of their heart disease. However very little is
      known about the non-cardiac ED patient BNP level. To utilize BNP as an accurate marker of
      cardiac disease in the pediatric ED, a clear difference between cardiac and non-cardiac
      patients needs to be demonstrated. If a large difference in BNP levels exists for the
      pediatric patient with heart disease who presents to the ED when compared to the child who
      presents to the ED with other non-cardiac disease processes, a useful marker of heart disease
      in children would be demonstrated.

      Objectives: The objective of the proposed research is to determine the typical BNP level in
      non-cardiac pediatric patients who present to the ED for evaluation of respiratory and/ or
      infectious processes. The endpoint of the project will be the collection of BNP levels from
      100 patients less than 6 years of age.

      Hypothesis 1 (H1): BNP levels for children with non-cardiac disease will be in the normal
      range (< 100pg/ml), and can be easily distinguished from the elevated levels seen in children
      with congenital or acquired heart disease.
    

Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Any child who is less than 6 years old seen in the Emergency Department evaluated for
        respiratory and/or infectious disease with order/s to have blood draw.
      
Keywords: Pediatrics; Non-cardiac Illness; B-type Natriuretic Peptide (BNP)