الفهرس 
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Abstract
Congenital and acquired heart disease contributes significantly to the disease related morbidity and mortality in children, especially in the first year of life.The recognition of heart disease in children can be challenging, because children often have a limited repertoire of presenting signs and symptoms (Kevin et al., 2008).
The diagnosis of heart disease can be especially difficult when children present at institutions that do not specialize in pediatric health care and are without ready access to pediatric echocardiography. Many cardiac disease states can mimic the more common illnesses of childhood, such as bronchiolitis, reactive airway disease, shock, acute abdomen, acute pulmonary odema and sepsis. In addition, infants with congenital heart disease can have neurologic abnormalities at the time of presentation. (Tissières et al., 2008).
Critical congenital heart disease is a term that refers to a group of serious heart defects that are present from birth. Critical heart disease was defined as patients who required intensive care admission for management of their disease. Non surgical indications for cardiac ICU admission included congenital and acquired heart disease with hemodynamic or respiratory instability(Christopher et al., 2008).
A reliable marker of heart disease in children would be of great benefit to those who practice pediatric health care and to the children in their care. Brain natriuretic peptide is part of a family of natriuretic peptides that affect the cardiovascular system. The natriuretic peptides are produced primarily by myocardial tissue in response to wall stress, modifying vascular tone, and volume homeostasis. BNP activates the membrane-bound guanylate cyclase-A receptor, with resultant smooth muscle and cardiac myocyte relaxation properties (Jasveer et al.,2009).
This study was a cross sectional case control study that was conducted on (115) cases of children between 2 days and 2 years, who were admitted to the pediatric and neonatal ICU .
The study included 3 -groups comparison, the cardiac group included (60) cases, (16) neonates and (44) infants, (37) males and (23) females. The non cardiac group included (35) cases, (7) neonates and (28) infants, (21) males and (14) females. The control group included (20) healthy children, (6) neonates and (14) infants, (10) males and (10) females.
All patients were subjected to the following:
- Detail history taking.
- Full general and systemic examinations.
- Investigations including :- Complete blood counts, C- reactive protein, elecrolytes, arterial blood gases, liver and kidney functions, plain X-rays and echocardiography. BNP levels was made for all patients and controls.
The study showed that ; 75% of the cardiac cases were congenital heart disease ( cyanotic and acyanotic) and 25% were aquired heart disease (dialated and hypertrophic cardiomyopathies).The cases of congenital heart disease were diagnosed as hemodynamic significant PDA , coarctation of aorta, hypoplastic left heart syndrome, sinus venosus anomalus pulmonary venous draing with ASD and PH, supracardiac type of total anomalous pulmonary venous return with ASD, Tetrology of Fallot, double outlet right ventricle with VSD, D-TGA with VSD, L-TGA with VSD, common A-V canal, truncus arteriosus, Ebstein anomalies of tricuspid valve, interrupted aortic arch, pulmonary atresia with VSD, a single ventricle with pulmonary stenosis and tricuspid atresia, congenital aortic stenosis.
The non cardiac cases were diagnosed as lobar pneumonia, bronchopneumonia, bronchiolitis, gastroenteritis with dehydration and shock, congenital lobar emphysema, diaphragmatic hernia, acute renal failure, renal tubular acidosis, meningoencephalitis, diabetic ketoacidosis, infant of diabetic mother with TTN , neonatal sepsis and glycogen storage disease with bronchopneumonia.
There were no statistical significant differences between the three studied groups regarding to sex. There was no statistical significant differences between the three studied groups regarding to age/days. The control group caused the significant increasing differences among the other groups regarding to weight and length, but no significant difference between the cardiac and non cardiac groups.
The non cardiac group caused the highly significant increasing differences among the other groups regarding to temperature, but no significant difference between the cardiac and control groups. There were highly statistical significant differences between the three studied groups regarding to heart rate and respiratory rate. There were no significant differences between the three studied groups regarding to systolic blood pressure. The control group caused the significant increasing differences among the other groups regarding to diastolic blood pressure, but no significant difference between the cardiac and non cardiac groups.
The control group caused the highly significant increasing differences among the other groups regarding to hemoglobin levels and hematocrit percentages, but no significant difference between the cardiac and non cardiac groups. There were highly statistical significant differences between the three studied groups regarding to WBCs and platelets counts, but no significant differences betweem them regarding to RBCs counts.
There were statistical significant differences between the three groups as regard to calcium and sodium levels, but no statistical significant differences betweem them regarding to potasium levels. There were statistical significant differences between the three groups as regard to as regard to ALT and CRP levels , but no statistical significant differences between them regarding to AST, urea and creatinine levels.
The control group caused the highly significant decreasing differences among the other groups regarding to PaCO2. It also caused the significant increasing differences among the other groups regarding to PaO2, but no significant difference between the cardiac and non cardiac groups.There were highly statistical significant differences between the three studied groups as regard to PH, HCO3 and oxygen saturation.
The study showed that; the cardiac group caused the highly significant increasing differences among the other groups regarding to the serum BNP levels, but no significant difference between the non cardiac and control groups. There was no significant difference between the congenital and aquired heart disease regarding to the serum BNP levels.
There was no significant difference between the cyanotic and acyanotic congenital heart disease, There was also no significant difference between between dialated and hypertrophic cardiomyopathies regarding to the serum BNP levels.
There were no significant differences between the serum BNP levels in males and females in the three studied groups. There was a highly significant difference between the serum BNP levels between neonates and infants in the control group, but no significant differences inbetween in the cardiac or non cardiac group.
There was no correlation between the serum BNP levels and vital signs or oxygen saturation in the cardiac or non cardiac group. There was a statistical significant increasing difference between the cardiac cases with heart failure and those without regarding to the serum BNP levels.
There was a highly significant negative correlation between the serum BNP levels and ejection fraction in the cardiomyopathy. There was no significant correlation between the serum BNP levels and pulmonary artery pressure in the cases with pulmonary hypertention or in those without.
There were statistical significant increasing differences between the died and survived cases regarding to the serum BNP levels in the cardiac and non cardiac groups.
تعد أمراض القلب الخلقية والمكتسبة من الأسباب المؤديه للوفيات في الأطفال خاصة في السنة الأولى من حياتهم. من المعروف ان أمراض القلب لدى الأطفال يمكن أن تكون صعبة التشخيص وذلك لتشابه الأعراض مع أمراض أخري وخاصا في دور الرعايه الصحيه غير المتخصصه والتي لآيتوافر فيها موجات صوتيه.
أمرض القلب الأكثر شيوعا تتشابه مع أمراض الطفولة كالتهاب الشعب الهوائيه , حساسيه الصدر، هبوط الدوره الدمويه, آلام البطن الحاده, تورم الرئتين الحاد و التسمم الدموي. بالأضافه الي ان أمراض القلب لدي الأطفال لها اعراض عصبيه في بدايتها.
أمراض القلب الحرجه قد يستدعي وجودها في العنايه المركزه للعلآج والتي تشمل أمراض القلب الخلقيه والمكتسبه مع عدم الأستقرار في الدوره الدمويه او الجهاز التنفسي .
هناك دراسات عديده قامت بتقييم مستوي ببتيد (ب) المدرللصوديوم والمبدئ له في أمراض القلب لدي الأطفال, ولكن لآ توجد تقارير سابقه قامت بتقييم مستواه كعرض اولي في أمراض قلب الأطفال الحرجه في وحده العنايه المركزه .
ببتيد (ب) المدر للصوديوم جزء من العائلة التي تؤثر علي نظام القلب الوعائي. ببتيد(ب) المدر للصوديوم ينتج بالدرجة الأولى من نسيج عضلة القلب ردا على الضغوط لتعديل لهجة الأوعية الدموية والتوازن الداخلي لحجم الدم . ببتيد (ب)المدر للصوديوم ينشط اﻷغشية المرتبطه بمستقبل الأنزيم المحبب وما ينجم عن ذلك بشكل سلس بعضلة القلب أواسترخاء خلآياه .
الهدف من البحث
تقييم مستوي الببتيد المخي المدرللصوديوم في حالات طوارئ امراض القلب لدي الأطفال في وحدات العنايه المركزه ومقارنتها بالحالآت الحرجه الأخري ومقارنتهما ايضا بأطفال أصحاء.