By doing so, providers will be able to decrease the rate of unplanned extubations in their PICU.
BNP and NTpBNP are good screening tools, detecting chronic ventricular dysfunction in adults, so with sensitivities and specificities surpassing clinical and radiological methods [4]. BNP and NTpBNP are useful in the diagnosis of congestive heart failure in dyspnoeic patients presenting to the emergency department [5]. In addition, these markers facilitate the screening, treatment response, and prognosis of asymptomatic patients with subclinical Left Ventricular dysfunction [6�C8]. BNP and NTpBNP levels are elevated in children with heart disease causing ventricular pressure and volume loading [9, 10].

In addition, plasma BNP correlates closely to shunt volume in left-to-right cardiac lesions, increasing with decreasing left ventricular ejection fraction, and positively correlating with increasing right ventricular systolic pressures [11]. The levels can also reflect functional capacity in children with congestive heart failure [9]. In children with dilated cardiomyopathy NTpBNP is a good marker for persistent left ventricular dysfunction with levels normalising in children whose echocardiograms recover [12]. Among infants with respiratory distress, plasma NTpBNP measurement can differentiate between acute heart failure and lung disease and can be used to monitor response to treatment [13]. Elevated preoperative NTpBNP in children undergoing open heart surgery is linked with complicated postoperative outcome [14]. NTpBNP is used preoperatively to predict the development of postoperative low cardiac output syndrome (LCOS) [15].

BNP levels tend to be higher in children receiving long-term immunosuppressive treatment Anacetrapib post liver transplant compared to healthy controls despite the lack of echocardiographic evidence of cardiac compromise suggesting that BNP levels may identify patients with early cardiac damage [16]. Limited data have demonstrated the potential benefit of these peptides as markers of cyanotic and obstructive lesions. Cowley et al. demonstrated a significant, correlation between left ventricle to aorta gradient and BNP levels [17]. NTpBNP has also been used to monitor response to valve replacement in patients with aortic stenosis [18]. In a recent study, Hopkins et al. found higher levels of NTpBNP in 10 adult patients with cyanotic heart disease (including Eisenmenger’s syndrome) despite the lack of ventricular pressure loading [19]. 3. Application of NTpBNP in Neonates BNP and NTpBNP levels surge at birth to reach a plateau on days 3 to 4, followed by a steady fall to reach a constant level in infancy [20].