Preliminary Experience With Nesiritide in the Pediatric Population

Abstract

Nesiritide is a recombinant formulation of brain-type natriuretic factor. Preliminary experience in the adult population suggests that nesiritide may be an effective agent in the treatment of decompensated congestive heart failure. Given its physiologic effects, it may be an effective agent in the pediatric population; however, to date, there are no reports regarding its use in infants and children. The authors retrospectively review their experience with nesiritide in 5 pediatric patients. The cohort of 5 patients included a diverse population with 2 patients who were status postcardiothoracic surgery, 2 with adult respiratory distress syndrome, and 1 in the recovery phase from septic shock. Although no direct measurement of cardiac output was feasible as none of the patients had a pulmonary artery catheter, other indicators of increased cardiac output were noted. These included improved peripheral perfusion with warming of the extremities and improvement of peripheral pulses in all of the patients, increased venous saturation in 2 of the patients, and maintenance of or increased urine output despite weaning or discontinuation of diuretics. In 3 of the patients, nesiritide was started as the primary agent to provide a decrease in systemic vascular resistance and augment cardiac output, while in the other 2 patients, nesiritide was used when other vasoactive agents failed to provide the desired effect or resulted in adverse effects.

Nesiritide in infants and children with congestive heart failure*

“…Marshall et al (7) reported the use of nesiritide in five pediatric patients, two of whom had previously undergone heart surgery. The authors suggested that the medication was well tolerated, although given the relatively small study population, analysis of beneficial hemodynamic effects was limited.…”

“…To date, there are limited data regarding the use of nesiritide in children with low cardiac output and CHF (7). Previous studies have demonstrated that low cardiac output is common after congenital heart surgery and is characterized by elevated filling pressures and impaired organ perfusion (8,9).…”

Nesiritide in the management of treatment refractory pediatric heart failure

“…Clinically, these variables are of interest primarily in relation to their effect on cardiac output. To date only one group has attempted to assay the effect of nesiritide on cardiac output, and they did so in a small group of patients (n 05) using qualitative clinical measures [10]. Studies with more precise assays are necessary to determine if nesiritide improves cardiac output in this population.…”

Treatment of acute kidney injury in children: from conservative management to renal replacement therapy

“…Other agents, such as nesiritide (recombinant B-type natriuretic peptide), have been tested in adults with AKI, but they have shown no impact on urine output, glomerular filtration rate, or need for RRT; however, these data are not necessarily applicable to pediatric patients. 22,23 Fenoldopam might improve urine output in pediatric AKI, but it has no effect on serum creatinine level. 24 These interventions might have a greater beneficial effect on AKI if they are initiated early in the disease course, the timing of which could be measured by increases in the levels of biomarkers of AKI.…”