Safety and efficacy of nesiritide in pediatric heart failure.
BACKGROUND
We hypothesized that recombinant B-type natriuretic peptide (BNP) (nesiritide) could improve urine output and neurohormonal markers of heart failure without worsening renal function in pediatric patients.


RESULTS
We analyzed our experience involving 140 nesiritide infusions in 63 consecutive children. Serum levels of BNP and electrolytes were measured before and after therapy. Dosing was begun at 0.01 mcg.kg.min without a bolus and titrated to a maximum of 0.03 mcg.kg.min, in 0.005-mcg.kg.min increments. Blood pressure, heart rate, and heart rhythm were monitored. In a substudy, 20 patients with decompensated cardiomyopathy-related heart failure received 72 hours of nesiritide with prospective assessment of aldosterone, norepinephrine, plasma renin, and endothelin-1 levels before and after therapy. The heart rate decreased significantly (P = .001). Urine output increased significantly on Days 1 and 3 (P < or = .001 and .004, respectively). The mean serum creatinine level decreased from 1.135 to 1.007 mg/dL (P < or = .001). In the substudy, aldosterone levels decreased from 37.5 +/- 57.1 to 20.5 +/- 41.9 ng/dL (P = .005). Plasma renin, norepinephrine, and endothelin-1 levels decreased nonsignificantly. Two infusions were discontinued because of hypotension.


CONCLUSIONS
Nesiritide safely treated decompensated heart failure in children. Increased urine output reflected improving renal function. Improved neurohormonal markers were seen after 72 hours of therapy, and complications were uncommon.
Jefferies
John L
JL
Division of Pediatric Cardiology, Texas Children's Hospital, Houston, Texas 77030, USA.
Price
Jack F
JF
Denfield
Susan W
SW
Chang
Anthony C
AC
Dreyer
William J
WJ
McMahon
Colin J
CJ
Grenier
Michelle A
MA
Clunie
Sarah K
SK
Thomas
Anne
A
Moffett
Brady S
BS
Wann
Tiffany S
TS
Smith
E O'Brian
EO
Towbin
Jeffrey A
JA
D000293:Adolescent; D000328:Adult; D000450:Aldosterone / Q000097:blood; D015415:Biomarkers / Q000097:blood; D002303:Cardiac Output, Low / Q000097:blood / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D009202:Cardiomyopathies / Q000150:complications / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D003404:Creatinine / Q000097:blood; D004231:Diuresis / Q000187:drug effects; D019332:Endothelin-1 / Q000097:blood; D005260:Female; D006333:Heart Failure; D006339:Heart Rate; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007668:Kidney / Q000503:physiopathology; D008297:Male; D045283:Natriuretic Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D020097:Natriuretic Peptide, Brain / Q000009:adverse effects* / Q000627:therapeutic use*; D009638:Norepinephrine / Q000097:blood; D011446:Prospective Studies; D012083:Renin / Q000097:blood; D016896:Treatment Outcome