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BNP Test Helps Diagnose Cardiac Conditions in Infants

New York (May 15, 2009)

Sleeping baby

While cardiologists frequently use B-type natriuretic peptide (BNP) to evaluate adult patients at risk for heart disease, pediatric cardiologists at the NewYork-Presbyterian Komansky Center for Children's Health/Weill Cornell Medical Center have also determined that the simple and inexpensive blood test can identify heart problems in infants, particularly patent ductus arteriosus. The BNP test, which can be given at bedside, speeds treatment and reduces the need for an echocardiogram.

"BNP was originally thought to originate in the brain – it used to be called brain natriuretic peptide – and it turns out that it's actually created by heart muscle in response to an increased burden on the heart," said Patrick A. Flynn, MD, Director of Noninvasive Imaging at the NewYork-Presbyterian Komansky Center for Children's Health/Weill Cornell Medical Center. "If the heart muscle notes increased stress or increased stretch, it liberates more of this substance, sending a signal out to the body for the blood vessels to become more dilated and telling the kidneys to increase the amount of urine production and the loss of sodium. That directly takes the burden off of the heart. So it's the heart's own way of recognizing a problem in its own function or in its own workload and correcting it."

Applicability of BNP Testing in Infants

Most of the diagnostic applicability of BNP has been in adult cardiology. Internists often use BNP levels when they must quickly determine whether a patient's complaints likely have a cardiac or pulmonary cause. The needs of pediatric cardiologists are different, according to Dr. Flynn. "We would usually identify congestive heart failure as the decreased ability of a structurally normal heart to keep up with the workload of day-to-day living. In pediatric cardiology, while we have patients with structurally normal hearts that have pump malformations, we also have patients whose hearts don't have any difficulty with the actual squeeze or performance of the heart muscle but still have an increased burden because of some structural or other abnormality."

Dr. Flynn and his team conducted a study published in the Journal of Pediatrics that compared BNP levels with the echocardiographic results for babies in the neonatal intensive care unit. "Specifically, we were looking for babies with patent ductus arteriosus, a persistent, abnormal opening between two major blood vessels leading from the heart that is a very common condition in premature newborns," said Dr. Flynn. "Typically we would find the ductus arteriosus and follow the magnitude of it using echocardiography. We showed in our study that you can identify babies that have a large ductus arteriosus, the ones that would require treatment, and also follow the progress of the ductus arteriosus using the bedside test for BNP."

Benefits of BNP as a Diagnostic Tool

The major reasons to focus on BNP as a diagnostic tool are that the test is easy to administer and relatively inexpensive. Although an echocardiogram can cost more than $1,000, a small bedside machine can test an infant's blood for BNP blood levels and return results in 10 to 15 minutes using a cartridge that costs about $25. According to Dr. Flynn, nursing staff can be trained to operate the BNP machine in very little time.

"The value of something like this in NICUs could be significant, especially in NICUs that are outside of major cardiac centers," said Dr. Flynn. "At these hospitals, obtaining an echocardiogram requires specialized staff to perform the test, pediatric cardiologists trained to read it, and the availability of the machine and its personnel." NewYork-Presbyterian Komansky Center for Children's Health/Weill Cornell Medical Center remains one of the few centers where BNP testing is routinely done in infants. "I think that old habits are hard to break," noted Dr. Flynn. "Certainly the evidence is there...I think we are probably just at the beginning of embracing BNP as a valuable diagnostic tool."

Faculty Contributing to this Article:

Patrick A. Flynn, MD, Director of Noninvasive Imaging at the NewYork-Presbyterian Komansky Center for Children's Health/Weill Cornell Medical Center and Associate Attending Pediatrician at NewYork-Presbyterian Hospital/Weill Cornell Medical Center, and Associate Professor of Clinical Pediatrics at Weill Cornell Medical College.

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