NPPB and hydrops fetalis: Althoughmetanalysis still shows uncertainties regarding the use of BNP to guide treatment inpatients with HF, the emergence of drugs (LCZ 696) acting directly on the enzymesystem (neprilysin inhibitors) responsible for the degradation of BNP demonstrated asignificant reduction in cardiovascular mortality in patients with heart failure andits clinical use is already authorized by regulatory agencies in somecountries[24,25].