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Journal of Intensive Care Medicine
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0885066608324296v1
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Article

Hemodynamic Effects and Safety of Nesiritide in Neonates With Heart Failure

Janet M. Simsic, MD1*, William T. Mahle, MD1, Angel Cuadrado, MD1, Paul M. Kirshbom, MD2, and Kevin O. Maher, MD1

1 Sibley Heart Center Cardiology
2 Division of Pediatric Cardiothoracic Surgery

* To whom correspondence should be addressed. E-mail: simsicj{at}kidsheart.com.


   Abstract

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.

First published on September 19, 2008, doi:10.1177/0885066608324296

Journal of Intensive Care Medicine 2008;23:389.

A more recent version of this article appeared on November 1, 2008


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