Natriuretic Peptide Biomarkers in Pediatric Cardiovascular Health
Summary
Natriuretic peptides, including atrial natriuretic peptide (ANP), B-type natriuretic peptide (BNP) and its cleavage fragment N-terminal pro-BNP (NT-proBNP), serve as endogenous regulators of fluid balance, vascular tone and myocardial remodelling. In children, developmental changes in myocardial structure, renal clearance and hormonal milieu demand age- and sex-specific reference ranges for accurate interpretation. Recent work has established that natriuretic peptide levels peak in the neonatal period and decline through infancy and adolescence, with divergent trajectories in boys and girls influenced by pubertal status, body mass index and lipid profiles. Clinically, natriuretic peptides aid in the detection and monitoring of congenital and acquired heart disease, including volume or pressure overload states, cardiomyopathies and heart failure complicating sepsis or respiratory distress. Non-invasive sampling—such as urinary NT-proBNP—offers potential for early diagnosis and risk stratification. Moreover, perioperative measurements around procedures such as corrective surgery for congenital defects or Fontan palliation provide insights into postoperative support needs and long-term outcomes. Despite robust correlations with echocardiographic indicators of ventricular dysfunction, gaps remain in validated paediatric cut-offs for diverse congenital anatomies. Ongoing efforts focus on integrating natriuretic peptide assays into clinical algorithms, refining point-of-care platforms, and exploring novel peptide variants (for example mid-regional pro-ANP) to enhance diagnostic precision and guide therapy in the paediatric population.
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Natriuretic Peptide Biomarkers in Pediatric Cardiovascular Health publication trend
The graph below shows the total number of articles in natriuretic peptide biomarkers in pediatric cardiovascular health across all publications each year (not limited to Nature Index journals).
Technical terms
B-type natriuretic peptide (BNP): A cardiac hormone released by ventricular myocytes in response to wall stretch, promoting vasodilation and natriuresis.
N-terminal pro-BNP (NT-proBNP): Inactive amino-terminal fragment cleaved from proBNP, used as a stable blood biomarker of cardiac stress.
Atrial natriuretic peptide (ANP): A peptide secreted by atrial cardiomyocytes under volume overload, with rapid release kinetics useful for monitoring acute haemodynamic changes.
Mid-regional pro-ANP (MR-proANP): A stable fragment of proANP used as a surrogate for ANP measurement, offering improved assay stability in clinical samples.
References
- Age-Dependent Reference Values for hs-Troponin T and NT-proBNP and Determining Factors in a Cohort of Healthy Children (The LIFE Child Study). Pediatric Cardiology (2022).
- Diagnostic Accuracy of NT-ProBNP for Heart Failure with Sepsis in Patients Younger than 18 Years. PLOS ONE (2016).
- Paediatric heart failure – understanding the pathophysiology and the current role of cardiac biomarkers in clinical practice. Cardiology in the Young (2023).
- Value of Follow‐Up N‐Terminal Probrain Natriuretic Peptide (NT‐proBNP) after a Modified Fontan Procedure. Cardiology Research and Practice (2021).
- Urinary NT-proBNP: A Useful Biomarker for the Diagnosis of Respiratory Distress in the Neonatal Population. Cureus (2023).
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