Hemodynamic effects and safety of nesiritide in neonates with heart failure.
OBJECTIVE
Evaluate effects and safety of nesiritide (Natrecor, Scios Inc.) human B-type natriuretic peptide, in neonates with heart failure.


METHODS
Seventeen neonates, not responding to conventional therapy, treated with nesiritide were retrospectively reviewed.


RESULTS
Average age 16 + 8 days; weight 3.2 + 0.6 kg. Fifteen treated with concomitant inotropic therapy; all with diuretics. Twelve received loading dose; followed by continuous infusions of 0.005 mcg/kg/min (2); 0.01 mcg/kg/min (12); 0.02 mcg/kg/min (3). Length of therapy 5 + 4 days. No change in heart rate or blood pressure between baseline, 1 hour or 24 hours of nesiritide infusion. Decrease central venous pressure (CVP) 24 hours after infusion (p = 0.03). Ins-out ratio improved in 29%. No difference in pre and post therapy BUN and creatinine (Cr). 18% had hypotension requiring intervention.


CONCLUSIONS
Nesiritide use in neonates may improve hemodynamics as demonstrated by reduction in CVP. All patients tolerated bolus dosing, however, transient hypotension occurred in 18% of neonates with continuous infusion.
Simsic
Janet M
JM
Sibley Heart Center Cardiology/Children's Healthcare of Atlanta, 2835 Brandywine Road, Atlanta, GA 30341, USA. simsicj@kidsheart.com
Mahle
William T
WT
Cuadrado
Angel
A
Kirshbom
Paul M
PM
Maher
Kevin O
KO
D006330:Heart Defects, Congenital / Q000601:surgery*; D006333:Heart Failure / Q000188:drug therapy; D006439:Hemodynamics / Q000187:drug effects*; D017052:Hospital Mortality; D006801:Humans; D007231:Infant, Newborn; D007262:Infusions, Intravenous; D045283:Natriuretic Agents / Q000009:adverse effects / Q000494:pharmacology* / Q000627:therapeutic use; D020097:Natriuretic Peptide, Brain / Q000009:adverse effects / Q000494:pharmacology* / Q000627:therapeutic use; D011184:Postoperative Period; D012189:Retrospective Studies; D012449:Safety
D045283:Natriuretic Agents; D020097:Natriuretic Peptide, Brain