Brief Report Diagnosing heart failure in children with congenital heart disease and respiratory syncytial virus bronchiolitis ☆ , ☆☆ ,★ Nir Samuel, MD a, d , Tova Hershkovitz, MD b, d , Riva Brik, MD b, d , Avraham Lorber, MD c, d , Itai Shavit, MD a, d, ⁎ a Pediatric Emergency Department, Rambam Health Care Campus, Haifa Israel b Department of Pediatrics B, Rambam Health Care Campus, Haifa Israel c Pediatric Cardiology and Adults with Congenital Heart Disease, Rambam Health Care Campus, Haifa, Israel d Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel abstract article info Article history: Received 15 August 2014 Received in revised form 29 August 2014 Accepted 1 September 2014 Objective: The objective of this study is to examine if the B-type natriuretic peptide (BNP) can be used in diagnos- ing heart failure (HF) in children with congenital heart disease (CHD) who present to the emergency department (ED) with acute bronchiolitis. Methods: A prospective cohort single-group study of children with CHD and respiratory syncytial virus bronchi- olitis was conducted in a pediatric ED. The reference standard for the presence of HF was the clinical and echo- cardiographic assessment of a pediatric cardiologist blinded to the BNP test results. Results: Eighteen cases were diagnosed, 7 (39%) had acute HF and 11 (61%) did not have acute HF. Patients with HF had a higher level of BNP compared with patients who did not have HF (783 pg/mL [interquartile range, 70-1345] vs 59 pg/mL [interquartile range, 23-90]; P b .013). A BNP level of 95 pg/mL was the opti- mal cutoff point, having a sensitivity of 0.71 (95% confidence interval, 0.29-0.96) and a specificity of 0.91 (95% confidence interval, 0.58-0.99). Conclusion: The results of this small study suggest that the BNP test can be useful to ascertain the presence of HF in children with CHD who present to the ED with respiratory syncytial virus bronchiolitis. © 2014 Elsevier Inc. All rights reserved. 1. Introduction B-type natriuretic peptide (BNP) is a natriuretic hormone produced in response to myocardial pressure and shear stress. B-type natriuretic peptide plasma levels reflect the heart's volume and pressure loads [1]. In recent years, following studies in adults, BNP has been extensively studied in pediatrics for the early diagnosis of cardiac disease as well as assessment of heart failure (HF) in a multitude of clinical situations [1,2]. The diagnosis of pediatric HF in the emergency department (ED) is challenging due to nonspecific symptoms and signs [3]. A previous pediatric study compared noncardiac patients who presented with respiratory symptoms with cardiac patients who presented with HF and reported that the BNP can be a useful test to differentiate between the 2 groups [4]. Infants and children with congenital heart disease (CHD) are at risk for developing HF when they have acute respiratory infections [5]. The objective of this study was to find out if the BNP can be used in diagnos- ing HF in children with CHD who present to the ED with respiratory syn- cytial virus (RSV) bronchiolitis. 2. Patients and methods 2.1. Study design A prospective cohort single-group study was conducted at the pedi- atric ED of Rambam Health Care Campus, a tertiary hospital in the north of Israel. During the study period, from October 1, 2010, to March 31, 2012, we enrolled patients with CHD and acute bronchiolitis. Patients were enrolled based on a convenience sample. The study was approved by the Rambam Health Care Campus Institutional Review Board. 2.2. Study protocol Children with known CHD who presented to the ED with a chief com- plaint of respiratory difficulty were eligible for enrollment. Congenital heart disease was defined as a known diagnosis of a congenital cardiac le- sion as previously decided by a pediatric cardiologist. Once the diagnosis of acute bronchiolitis was established by the ED physician, study American Journal of Emergency Medicine 32 (2014) 1510–1512 ☆ Authors' contribution information: NS conceived the idea for the study, collected the data, reviewed the literature, and critically reviewed the manuscript; TH collected the data; RB and AL directed study implementation; and IS wrote the manuscript, analyzed the data, performed the statistical analysis, and reviewed the literature. NS has full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. ☆☆ Conflict of interest: None declared. ★ Funding: None declared. ⁎ Corresponding author. Pediatric Emergency Department, Rambam Health Care Campus, 6 Ha'Aliya St, Bat Galim, Haifa, ISRAEL, 31096. Tel.: +972 50 2063239. E-mail address: itai@pem-database.org (I. Shavit). http://dx.doi.org/10.1016/j.ajem.2014.09.005 0735-6757/© 2014 Elsevier Inc. All rights reserved. Contents lists available at ScienceDirect American Journal of Emergency Medicine journal homepage: www.elsevier.com/locate/ajem