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Hemodynamic Effects and Safety of Nesiritide in Neonates with Heart Failure

Sibley Heart Center Cardiology/Children's Healthcare of Atlanta, Atlanta, Georgia, simsicj{at}kidsheart.com

William T. Mahle, MD

Sibley Heart Center Cardiology/Children's Healthcare of Atlanta, Atlanta, Georgia

Angel Cuadrado, MD

Sibley Heart Center Cardiology/Children's Healthcare of Atlanta, Atlanta, Georgia

Paul M. Kirshbom, MD

Division of Pediatric Cardiothoracic Surgery, Emory University, Children's Healthcare of Atlanta, Atlanta, Georgia

Kevin O. Maher, MD

Sibley Heart Center Cardiology/Children's Healthcare of Atlanta, Atlanta, Georgia

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.

Key Words: congenital heart disease • neonate • heart failure • B-type natriuretic peptide • postoperative care

This version was published on November 1, 2008

Journal of Intensive Care Medicine, Vol. 23, No. 6, 389-395 (2008)
DOI: 10.1177/0885066608324296


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