<p class="a">Natriuretic peptides (NUP) are peptide hormones secreted by cardiomyocytes in response to a volume overload of the heart. Emphasis in the article is placed on the history of NUP discovery, their chemical structure and pathophysiological mechanisms of action. The data on determination of NUP reference values in children with cardiac pathologies are analyzed. A NUP clinical significance in early diagnosis of heart failure in children, including those with congenital heart defects is shown. Also considered is NUP dynamics after surgical correction of congenital heart defects. A conclusion is drawn that NUP play an important prognostic role in evaluating early and late postoperative periods and disease outcomes on a whole.</p><p align="JUSTIFY">Received 11 October 2016. Accepted 22 December 2016.</p><p align="JUSTIFY"><strong>Funding: </strong>The study had no sponsorship.</p><p align="JUSTIFY"><strong>Conflict of interest: </strong>The authors declare no conflict of interest.</p><p align="JUSTIFY"><strong>Author contributions</strong></p><p align="JUSTIFY">All authors contributed equally at all stages of the research.</p>
Background. Congenital heart defects (CHD) are the most common type of developmental anomalies in children. At present the early diagnosis of congestive heart failure (CHF) and CHF-associated pathologic conditions is becoming increasingly important for optimization of protocols for following up pediatric patients in the primary health care settings.Objective. The study aimed at determining the prognostic role of brain natriuretic peptide (BNP) as a diagnostic marker of CHF progression and development of CHF-associated pathological conditions in babies with CHD during the first year of life.Methods. A prospective cohort study was carried out in a total of 114 children of the first year of life. The main study group was comprised of 61 children with confirmed diagnosis of CHD, and the control group of 53 health status group I–IIA children without CHD.Results. Diagnostic role of BNP elevation > 30 pg/mL was determined. At this BNP level the risk for developing stage 2A CHF increased 7-fold (OR 7.5 [1.8–31.5]), for developing functional class (FC) 2 CHF — nearly 5-fold (OR 4.6 [1.3–16.0]), and for FC 3 CHF such risk increased 9-fold (OR 9.2 [2.3–36.1]). Our results demonstrated that the BNP level measurements can be used in clinical practice to determine the likelihood of persistence of symptoms of perinatal CNS injuries during the first year of life (OR 7.6 [1.7–34.5]) and protein and energy deficit (PED) (OR 9.5 [2.5–35.5]) in children with CHD.
Background. Congenital heart defects (CHD) are the most common type of developmental anomalies in children. At present the early diagnosis of congestive heart failure (CHF) and CHF-associated pathologic conditions is becoming increasingly important for optimization of protocols for following up pediatric patients in the primary health care settings.Objective. The study aimed at determining the prognostic role of brain natriuretic peptide (BNP) as a diagnostic marker of CHF progression and development of CHF-associated pathological conditions in babies with CHD during the first year of life.Methods. A prospective cohort study was carried out in a total of 114 children of the first year of life. The main study group was comprised of 61 children with confirmed diagnosis of CHD, and the control group of 53 health status group I–IIA children without CHD.Results. Diagnostic role of BNP elevation > 30 pg/mL was determined. At this BNP level the risk for developing stage 2A CHF increased 7-fold (OR 7.5 [1.8–31.5]), for developing functional class (FC) 2 CHF — nearly 5-fold (OR 4.6 [1.3–16.0]), and for FC 3 CHF such risk increased 9-fold (OR 9.2 [2.3–36.1]). Our results demonstrated that the BNP level measurements can be used in clinical practice to determine the likelihood of persistence of symptoms of perinatal CNS injuries during the first year of life (OR 7.6 [1.7–34.5]) and protein and energy deficit (PED) (OR 9.5 [2.5–35.5]) in children with CHD.
Background. Congenital heart defects (CHD) are the most common type of developmental anomalies in children. At present the early diagnosis of congestive heart failure (CHF) and CHF-associated pathologic conditions is becoming increasingly important for optimization of protocols for following up pediatric patients in the primary health care settings.Objective. The study aimed at determining the prognostic role of brain natriuretic peptide (BNP) as a diagnostic marker of CHF progression and development of CHF-associated pathological conditions in babies with CHD during the first year of life.Methods. A prospective cohort study was carried out in a total of 114 children of the first year of life. The main study group was comprised of 61 children with confirmed diagnosis of CHD, and the control group of 53 health status group I–IIA children without CHD.Results. Diagnostic role of BNP elevation > 30 pg/mL was determined. At this BNP level the risk for developing stage 2A CHF increased 7-fold (OR 7.5 [1.8–31.5]), for developing functional class (FC) 2 CHF — nearly 5-fold (OR 4.6 [1.3–16.0]), and for FC 3 CHF such risk increased 9-fold (OR 9.2 [2.3–36.1]). Our results demonstrated that the BNP level measurements can be used in clinical practice to determine the likelihood of persistence of symptoms of perinatal CNS injuries during the first year of life (OR 7.6 [1.7–34.5]) and protein and energy deficit (PED) (OR 9.5 [2.5–35.5]) in children with CHD.
П о данным Европейского международного реги-стра врожденных пороков развития, врожден-ные пороки сердца (ВПС) являются самой рас-пространенной группой аномалий развития у детей и остаются ведущей причиной смерти [1]. В настоящее время отмечается тенденция к увеличению числа и тяже-сти регистрируемых ВПС [2]. Летального исхода и высоко-го процента инвалидности можно избежать, используя современные методы оперативной коррекции [3]. Современный уровень оказываемых оперативных техно-логий обеспечивает выживание детей практически со всеми дефектами [2] и, как следствие, быстрый рост попу-ляции детей и подростков с оперированными ВПС [2,4]. Сроки проведения оперативного вмешательства опреде-ляются индивидуально исходя из тяжести состояния пациента, имеющихся нарушений гемодинамики, сопут-ствующей патологии. Поэтому, как правило, проведения оперативной коррекции в периоде новорожденности и в раннем младенческом возрасте требуют тяжелые ВПС, приводящие при отсутствии своевременно оказанной хирургической помощи к выраженным нарушениям функционирования организма или летальному исходу [5]. Особого внимания заслуживают критические пороки, которые характеризуются дуктус-зависимым легочным или системным кровообращением. Понятие «критиче-ский порок» применяется для обозначения ВПС, сопрово-ждающихся развитием критических состояний в ближай-шие часы или сутки после рождения [6]. К критическим E.V. SAPEROVA, I.V. VAСHLOVA, MD, Prof. Urals State Medical University» of the Ministry of Healthcare of the Russian Federation THE COMPLEX ASSESSMENT OF THE HEALTH STATUS OF CHILDREN DURING THE FIRST YEAR OF LIFE WITH CONGENITALHEART DISEASE In article we demonstrated the results of the complex assessment of the health status of children during the first year of life with congenital heart defects (CHD). We established a connection between the problems of obstetric history (miscarriage, abortion) and an increased risk of developing severe heart defects. In the group of children with CHD who required surgery for 1 year of life and who have mothers with obstetric history problems, the severity of the CHD in 55% [95% Cl 44,7÷65,0] of children was related to the impact of obstetric history problems on their mothers. We found out that the majority of children with CHD had low body weight by the end of 1 year of life. In the group of operated children, we found a significant increase in the proportion of children with a sharply disharmonious physical development due to a deficit in body weight. We identified that children with CHD requiring surgery for 1 year of life have a high risk of respiratory infections (ОR = 4,67 95% Cl [1,19 ÷ 18,35]). In addition, we found a positive relationship between the respiratory incidence and the degree of heart failure in children with CHD (r = 0,492, p<0,05). The data has been demonstrated the severity of hemodynamic disorders at CHD requiring surgical correction at an early age. The results of a comprehensive assessment of children's health are important for developing algorithms for monitoring children with...
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