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PEDIATRIC ANESTHESIA

Time Course and Prognostic Value of Plasma B-type Natriuretic Peptide Concentration in Neonates Undergoing the Arterial Switch Operation

Maxime Cannesson, MD^*, Clara Bionda, MD, Bruno Gostoli, MD^*, Olivier Raisky, MD, PhD, Sylvie di Filippo, MD, PhD, Dominique Bompard, MD^*, Catherine Védrinne, MD, PhD^*, Robert Rousson, MD, PhD, Jean Ninet, MD, Jean Neidecker, MD^*, and Jean-Jacques Lehot, MD, PhD^*

From the Departments of *Anesthesiology and Intensive Care, Biochemistry, Cardiac Surgery, and Pediatric Cardiology, Hospices Civils de Lyon, Louis Pradel Hospital and Claude Bernard Lyon 1 University, Lyon, France.

Address correspondence and reprint requests to Maxime Cannesson, Service d'Anesthésie Réanimation, Hôpital Cardiologique Louis Pradel, 200 avenue du Doyen Lépine, 69500 Bron, France. Address e-mail to maxime_cannesson{at}hotmail.com.

BACKGROUND: Plasma B-type natriuretic peptide (BNP) can predict postoperative complications after cardiac surgery in adults. Our aim was to investigate BNP kinetics and prognostic value in neonates undergoing the arterial switch operation (ASO) for transposition of the great arteries (TGA).

METHODS: We measured BNP concentrations in 30 neonates before, immediately after, and 6, 12, 24, and 48 h after ASO for TGA. Complicated postoperative evolution was defined as patients requiring mechanical ventilation or presenting low cardiac output syndrome for more than 72 h. We studied the ability of postoperative BNP concentrations to predict complicated evolution.

RESULTS: Intubation duration, inotropic support duration, and intensive care unit stay were 68 (48–121) h, 78 (69–141) h, and 96 (76–149) h respectively. Patients with complicated evolution had higher 6 and 12-h BNP concentrations than patients with simple evolution (459 (210–897) vs 137 (67–248) ng/L and 547 (193–868) vs 185 (79–354) ng/L respectively; P < 0.05) and had longer intubation, inotropic support, and intensive care unit stay (96 (70–190) vs 50 (48–66) h, 100 (83–190) vs 70 (59–72) h, and 120 (90–240) vs 84 (72–96) h, P < 0.05). A 6-h BNP concentration >160 ng/L was able to predict complicated evolution with a sensitivity of 93% and a specificity of 67%.

CONCLUSION: In neonates, BNP concentrations can predict adverse outcome in the postoperative period after ASO for TGA. This marker has potential clinical applications.

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Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999