Accuracy of Plasma B-Type Natriuretic Peptide to Diagnose Significant Cardiovascular Disease in Children. The Better Not Pout Children! Study

Yuk M. Law, Andrew W. Hoyer, Mark D. Reller, Michael Silberbach

Research output: Contribution to journalArticle

69 Scopus citations


Objectives: The purpose of this study was to assess the ability of plasma B-type natriuretic peptide (BNP) to diagnose significant cardiovascular disease (CVD) in the pediatric population. Background: BNP has been shown to be reliable in detecting ventricular dysfunction and heart failure in adults. Timely and accurate identification of significant pediatric heart disease is important but challenging. A simple blood test could aid the front-line physician in this task. Methods: Subjects without a history of heart disease with findings possibly attributable to significant CVD in the acute care setting requiring a cardiology consult were enrolled. Clinicians were blinded to the BNP result, and confirmation of disease was made by cardiology consultation. Results: Subjects were divided into a neonatal (n = 42, 0 to 7 days) and older age group (n = 58, >7 days to 19 years). CVD was present in 74% of neonates and 53% of the older age group. In neonates with disease, median BNP was 526 pg/ml versus 96 pg/ml (p < 0.001) for those without disease. In older children with disease, median BNP was 122 pg/ml versus 22 pg/ml in those without disease (p < 0.001). Subjects with disease from an anatomic defect, a longer hospital stay, or who died had higher BNP. A BNP of 170 pg/ml yielded a sensitivity of 94% and specificity of 73% in the neonatal group and 87% and 70% in the older age group, respectively, using a BNP of 41 pg/ml. Conclusions: BNP is a reliable test to diagnose significant structural or functional CVD in children. Optimal cutoff values are different from adult values.

Original languageEnglish (US)
Pages (from-to)1467-1475
Number of pages9
JournalJournal of the American College of Cardiology
Issue number15
StatePublished - Oct 6 2009



  • B-type natriuretic peptide
  • biomarkers
  • cardiovascular disease
  • children
  • heart failure

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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