Safety and Efficacy of Nesiritide in Pediatric Heart Failure

Jefferies, John L.; Price, Jack F.; Denfield, Susan W.; Chang, Anthony; Dreyer, William J.; McMahon, Colin J.; Grenier, Michelle A.; Clunie, Sarah K.; Thomas, A.; Moffett, Brady S.; Wann, Tiffany S.; Smith, E. O’Brian; Towbin, Jeffrey A.

doi:10.1016/j.cardfail.2007.04.005

Cited by 32 publications

(21 citation statements)

References 39 publications

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“…by guest on May 12, 2018 http://circheartfailure.ahajournals.org/ Downloaded from associated with favorable changes in hemodynamics, fluid balance, renal function, and overall clinical status. 7,8,14,16 The results of our trial stand in contrast to the findings of these pediatric studies, but our study design overcame many of the inherent limitations of retrospective case series.…”

Section: Discussionmentioning

confidence: 79%

“…At the onset of this trial, the use of nesiritide in critically ill pediatric cardiac patients was the subject of investigation and speculation, [7][8][9]14 and our findings should be interpreted in light of prior perioperative investigations of these drugs. In a phase II clinical trial in 303 adults with pre-existing heart failure who underwent coronary artery bypass grafting using CPB, patients assigned to receive empirical perioperative nesiritide infusions had significant improvements in urine output, renal function, hospital length of stay, and 6-month mortality.…”

Section: Discussionmentioning

confidence: 88%

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Impact of Empiric Nesiritide or Milrinone Infusion on Early Postoperative Recovery After Fontan Surgery

Costello

Dunbar‐Masterson

Allan

et al. 2014

Circ: Heart Failure

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Background-We sought to determine whether empirical nesiritide or milrinone would improve the early postoperative course after Fontan surgery. We hypothesized that compared with milrinone or placebo, patients assigned to receive nesiritide would have improved early postoperative outcomes. Methods and Results-In a single-center, randomized, double-blinded, placebo-controlled, multi-arm parallel-group clinical trial, patients undergoing primary Fontan surgery were assigned to receive nesiritide, milrinone, or placebo. A loading dose of study drug was administered on cardiopulmonary bypass followed by a continuous infusion for ≥12 hours and ≤5 days after cardiac intensive care unit admission.

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Section: Discussionmentioning

confidence: 79%

Section: Discussionmentioning

confidence: 88%

Impact of Empiric Nesiritide or Milrinone Infusion on Early Postoperative Recovery After Fontan Surgery

Costello

Dunbar‐Masterson

Allan

et al. 2014

Circ: Heart Failure

View full text Add to dashboard Cite

show abstract

“…Retrospective case series in pediatric heart failure patients, including some patients recovering from cardiac surgery, concluded that nesiritide was generally well tolerated and had a favorable impact on diuresis, cardiac filling pressures, and overall clinical status (147)(148)(149)(150). In an uncontrolled, prospective trial of 32 pediatric patients with congestive heart failure, nesiritide was associated with improved urine output, decreased CVP, and improved functional status.…”

Section: Nesiritidementioning

confidence: 95%

Pediatric Cardiac Intensive Care Society 2014 Consensus Statement

McCammond

Axelrod

Bailly

et al. 2016

Pediatric Critical Care Medicine

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Fluid management is challenging in critically ill pediatric cardiac patients. A myriad of causes may be contributory, including intrinsic myocardial dysfunction with its associated neuroendocrine response, renal dysfunction with oliguria, and systemic inflammation with resulting endothelial dysfunction. The development of fluid overload has been associated with adverse outcomes, including acute kidney injury, prolonged mechanical ventilation, increased vasoactive support, prolonged hospital length of stay, and mortality. An in-depth understanding of the many factors that influence volume status is necessary to guide optimal management.

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“…We reported our experience with 143 nesiritide infusions in 63 consecutive children who were hospitalized in the intensive care unit for symptomatic heart failure [47]. Continuous infusions of nesiritide (0.01-0.03 μg/kg/min) were associated with decreased heart rate, increased urine output, neurohormonal attenuation, and improved renal function after 72 hours of therapy.…”

Section: Management Of Cardiorenal Syndrome In Childrenmentioning

confidence: 95%

“…It has been used for the treatment of ADHF in both adults and children, providing improved hemodynamics and increased urine output while avoiding some of the adverse side effects of inotropic agents [46,47]. Low-dose nesiritide may provide a renal protective effect in adult patients with decompensated heart failure and renal dysfunction.…”

Section: Management Of Cardiorenal Syndrome In Childrenmentioning

confidence: 98%

Cardiorenal syndrome in children with heart failure

Price

Goldstein²

2009

Curr Heart Fail Rep

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Concomitant cardiac and renal dysfunction has been termed the cardiorenal syndrome (CRS). This clinical condition usually manifests as heart failure with worsening renal function and occurs frequently in the acute care setting. A consistent definition of CRS has not been universally agreed upon, although a recent classification of CRS describes several subtypes depending on the primary organ injured and the chronicity of the injury. CRS may develop in adults and children and is a strong predictor of morbidity and mortality in hospitalized and ambulatory patients. The underlying physiology of CRS is not well understood, creating a significant challenge for clinicians when treating heart failure patients with renal insufficiency. This review summarizes recent data characterizing the incidence, physiology, and management of children who have heart failure and acute kidney injury.

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Safety and Efficacy of Nesiritide in Pediatric Heart Failure

Cited by 32 publications

References 39 publications

Impact of Empiric Nesiritide or Milrinone Infusion on Early Postoperative Recovery After Fontan Surgery

Impact of Empiric Nesiritide or Milrinone Infusion on Early Postoperative Recovery After Fontan Surgery

Pediatric Cardiac Intensive Care Society 2014 Consensus Statement

Cardiorenal syndrome in children with heart failure

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