Plasma concentration of N-terminal pro-atrial and N-terminal pro-brain natriuretic peptides and fluid balance in children with bronchiolitis

K Alex Daneshmand; Arno L Zaritsky; Melissa A Lamb; Ann Marie LeVine; Douglas W Theriaque; Ronald C Sanders

doi:10.3233/PIC-2012-024

Plasma concentration of N-terminal pro-atrial and N-terminal pro-brain natriuretic peptides and fluid balance in children with bronchiolitis

J Pediatr Intensive Care. 2012 Sep;1(3):143-151. doi: 10.3233/PIC-2012-024.

Authors

K Alex Daneshmand¹, Arno L Zaritsky², Melissa A Lamb³, Ann Marie LeVine⁴, Douglas W Theriaque⁵, Ronald C Sanders⁶

Affiliations

¹ Pediatric Critical Care Medicine, Lee Memorial Hospital, Fort Meyers, FL, USA.
² Executive Medical Director, Children's Hospital of The King's Daughters, Norfolk, VA, USA.
³ Pediatric Critical Care Medicine, University of Florida, Gainesville, FL, USA.
⁴ Pediatric Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA.
⁵ Clinical and Translational Science Institute, University of Florida, Gainesville, FL, USA.
⁶ Section of Pediatric Critical Care, UAMS/Arkansas Children's Hospital, Little Rock, AR, USA.

Abstract

The aim of this study was to evaluate the plasma levels of N-Terminal pro-brain natriuretic peptide (N-BNP), N-Terminal pro-atrial natriuretic peptide (N-ANP) and antidiuretic hormone (ADH) over time and their relationship to clinical indicators in hospitalized children with bronchiolitis. Prospective crossover clinical investigation. Hospitalized children in a university-affiliated hospital. Twenty-seven children (birth to 24 mo) with first episode of bronchiolitis and 34 age-matched healthy controls. Daily blood samples up to five consecutive days were obtained for N-BNP, N-ANP and ADH in the bronchiolitis group and on the initial blood draw in the control group. Daily total fluid intake, net fluid balance and clinical bronchiolitis severity levels were recorded. N-BNP and N-ANP levels were measured by enzyme-linked immunosorbent assay. ADH levels were measured by a double antibody technique. The mean age (months ± SD) in the bronchiolitis group was 4.2 ± 5.9 mo and 12.0 ± 6.1 mo in the control group; 51.9% of bronchiolitis patients were positive for respiratory syncytial virus (RSV). In patients with bronchiolitis on admission, plasma N-BNP measurements (mean ± SD) were elevated (996.0 ± 570.2 fmol/mL) compared to controls (552.7 ± 264.7 fmol/mL P < 0.005). Serum N-ANP levels were also initially elevated (3,889 ± 1,769.7 fmol/mL) compared to controls (2,173 ± 912 fmol/mL P < 0.005). The serum levels of N-BNP and N-ANP remained significantly elevated from day 2 through day 5. Similarly, ADH levels were significantly higher on admission in the bronchiolitis group (10 ± 7.49 pg/mL) vs. the control group (5.8 ± 5.5 pg/mL P < 0.05), but quickly decreased from day 2 through day 5. N-BNP, N-ANP and ADH concentrations were elevated in hospitalized children with bronchiolitis at admission. Based on our observation, judicious fluid management is indicated in children hospitalized with bronchiolitis.

Keywords: Brain natriuretic peptide; antidiuretic hormone; arginine vasopressin; atrial natriuretic peptide; bronchiolitis; fluid management; intensive care unit; pediatric; respiratory distress.