Nesiritide therapy in a term neonate with renal disease.
A term (39-wk-old) male neonate exhibited respiratory distress and anuria within 2 days of birth. The patient was diagnosed with pulmonary hypertension, polycystic kidney disease, and heart failure; his initial B-type natriuretic peptide concentration was 2460 pg/ml. After minimal response to loop diuretics, the patient was given an infusion of nesiritide 0.01 microg/kg/minute, with no loading dose. Urine output increased over 400%, and cardiac function improved. Nesiritide was titrated to 0.03 microg/kg/minute with no hypotension, decreased renal function, or adverse cardiac sequelae over the next 6 days. No subsequent changes in cardiac function occurred during the infant's stay in a progressive care unit, but he died at age 5.5 months due to sepsis. This case report demonstrates the successful first use of nesiritide therapy in a neonate with renal disease. Further studies are warranted to evaluate the safety and administration of this agent in the neonatal patient population.
Moffett
Brady S
BS
Department of Pharmacy, Texas Children's Hospital, Houston, Texas 77030, USA. bsmoffet@texaschildrenshospital.org
Jefferies
John L
JL
Rossano
Joseph
J
Towbin
Jeffrey A
JA
D001806:Blood Urea Nitrogen; D004232:Diuretics / Q000627:therapeutic use; D004562:Electrocardiography; D017809:Fatal Outcome; D006330:Heart Defects, Congenital / Q000503:physiopathology; D006333:Heart Failure / Q000150:complications / Q000151:congenital; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications / Q000151:congenital; D007231:Infant, Newborn; D008297:Male; D045283:Natriuretic Agents / Q000627:therapeutic use*; D020097:Natriuretic Peptide, Brain / Q000627:therapeutic use*; D007690:Polycystic Kidney Diseases / Q000151:congenital* / Q000188:drug therapy*
D004232:Diuretics; D045283:Natriuretic Agents; D020097:Natriuretic Peptide, Brain