HeartCalc / HF

Pediatric Heart Failure Experimental

NT-proBNP against age- and sex-specific reference limits (1 to 19 years); Ross and NYU PHFI scores described and linked

Ross classification, age-stratified revision (Ross 2012) Not calculated here

Ross proposed an age-based revision of the Ross heart failure classification that grades signs and symptoms differently in infants, toddlers and older children and adds echocardiography, exercise testing and NT-proBNP. The abstract states that "testing of this new system will be important" before it can unify grading. The scoring table (Table 4) is in the subscription article and could not be retrieved for this prototype, so no score is calculated: guessing criteria or cut-offs would be unsafe.

Correct DOI: 10.1007/s00246-012-0306-8 (Pediatr Cardiol 2012;33(8):1295-1300; PubMed 22476605).
Several later studies report "modified Ross" totals in bands such as 3–6 mild, 7–9 moderate and 10–12 severe, but they use differing versions; those bands are not taken from the 2012 primary text here [unverified].

Ross 2012, Pediatric Cardiology →

NYU Pediatric Heart Failure Index (Connolly 2001) Not calculated here

The NYU PHFI is a weighted, linear combination of scores for symptoms, physical signs and the medical regimen. In the derivation paper, healthy children scored 0 to 2; infants under 2 years with left-to-right shunts fell from a mean of 11.4 before surgery to 1.8 after repair, and the inter-observer correlation was 0.95 (abstract). The item weights are in the subscription article and were not retrieved, so the index is not calculated here.

Connolly 2001, J Pediatr →

Model, equations and sources

NT-proBNP reference (Mu 2023, Table 3, robust method)

ratio = NT-proBNP [ng/L] / URL [ng/L]          (1 pg/mL = 1 ng/L)
above = NT-proBNP > URL                         (URL = 97.5th percentile)

Median and 97.5th percentile, ng/L
Age	Boys median	Boys 97.5th	Girls median	Girls 97.5th

Population: healthy NHANES 1999–2004 participants (5,250 healthy children and adolescents), stored serum measured 2018–2020 with the Roche Elecsys NT-proBNP assay (e601). Ages start at 1 year.
Values were read from the publisher's HTML table (two independent reads agreed). The paper is © AACC; only the medians and upper limits needed are shown.
A value above the 97.5th percentile is outside the healthy reference range; it is not a heart failure diagnosis and is not a validated severity threshold. Renal function and other conditions raise NT-proBNP.
Not implemented: infant reference values (Nir 2009, combined data from four studies; full text not retrieved [unverified]). NT-proBNP is highest in the first days of life and falls steeply over the first weeks (Nir 2009 abstract).

References

Mu S, Echouffo-Tcheugui JB, Ndumele CE, et al. NT-proBNP reference intervals in healthy U.S. children, adolescents, and adults. J Appl Lab Med 2023;8(4):700-712. doi:10.1093/jalm/jfad024 (Table 3)
Ross RD. The Ross classification for heart failure in children after 25 years: a review and an age-stratified revision. Pediatr Cardiol 2012;33(8):1295-1300. doi:10.1007/s00246-012-0306-8 (abstract only retrieved)
Connolly D, Rutkowski M, Auslender M, Artman M. The New York University Pediatric Heart Failure Index. J Pediatr 2001;138(5):644-648. doi:10.1067/mpd.2001.114020 (abstract only retrieved)
Nir A, Lindinger A, Rauh M, et al. NT-pro-B-type natriuretic peptide in infants and children: reference values based on combined data from four studies. Pediatr Cardiol 2009;30(1):3-8. doi:10.1007/s00246-008-9258-4 (abstract only retrieved)

Compares one NT-proBNP value with a healthy reference population. It does not grade heart failure severity.

Experimental. Check every result against the primary references.

Patient

NT-proBNP

Ross classification, age-stratified revision (Ross 2012) Not calculated here

NYU Pediatric Heart Failure Index (Connolly 2001) Not calculated here

NT-proBNP reference (Mu 2023, Table 3, robust method)

References