Background and study aim: Brain Natriuretic Peptide (BNP) and N-Terminal pro-Brain Natriuretic Peptide (NT-pro BNP) are frequently used in the diagnosis of congestive heart failure (CHF), especially for distinguishing between patients with dyspnea of cardiac and pulmonary origin. The present work aimed at evaluating N-Terminal pro-Brain Natriuretic Peptide (NT-proBNP) as a biomarker for diagnosis of congestive heart failure (CHF) in pediatrics and as well as its severity and hence, helping early diagnosis of CHF in absence of rapid echocardiographic examination. Subjects and Methods: The patients group (group I) consisted of 45 children (Session [UserIDID] males and 21 females) aging between 45 days and 12 years. All having the inclusion criterion of CHF. They were subclassified into: group I-1 including 15 patients having dilated cardiomyopathy (DCM), group I-2 including 15 patients having congenital heart disease (CHD) and group I-3 including 15 patients that have developed CHF due to non-cardiac causes. The control group was formed of 15 healthy children (group II) matched in age and gender with the patients groups. All children were subjected to full history taking, physical examination, classification of clinical severity of CHF cases according to Modified Ross Score, imaging and laboratory investigations including serum level of NT-proBNP. Results: The study revealed that serum NT-proBNP showed a highly statistically significant increase in CHF cases three groups (I-1, I-2 and I-3) in comparison to the control group (group II) (P<0.001). NT-proBNP level showed highly statisticallysignificant positive correlation with CHF class of clinical severity (P<0.001). Regarding echocardiographic parameters NT-proBNP showed a highly significant positive correlation with left ventricular end diastolic dimensions (LVEDD) and left ventricular end systolic dimensions (LVESD), and a highly significant negative correlation with left ventricular (LV) ejection fraction (EF), fractional shortening (FS) and mitral valve E/A ratio. At cutoff level of 1500 pg/ml, the sensitivity of NT-proBNP as a diagnostic biomarker in children with CHF was 98% and the specificity was 100%. Conclusion: NT-proBNP is significantly statistically correlated with clinical severity of CHF and echocardiographic parameters of CHF cases of different causes .We highly recommend a long-term study on the value of the level of NT-proBNP as a prognostic risk parameter.