Safety and Efficacy of Nesiritide in Pediatric Heart Failure

Abstract

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.

METHODS AND 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 ≤ .001 and .004, respectively). The mean serum creatinine level decreased from 1.135 to 1.007 mg/dL (P ≤ .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.

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