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Preliminary Experience With Nesiritide in the Pediatric Population

University of Missouri School of Medicine

John W. Berkenbosch, MD

Department of Child Health, University of Missouri, Columbia, Missouri

Pierantonio Russo, MD

Department of Cardiothoracic Surgery, University of Missouri, Columbia, Missouri

Joseph D. Tobias, MD

Department of Anesthesiology, University of Missouri, Columbia, Missouri, tobiasj{at}health.missouri.edu

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.

Key Words: nesiritide • congenital heart disease • septic shock • high-frequency ventilation

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Journal of Intensive Care Medicine, Vol. 19, No. 3, 164-170 (2004)
DOI: 10.1177/0885066604263828


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