Nesiritide in the management of treatment refractory pediatric heart failure

Abstract

Objective. To describe the impact of nesiritide on critically ill children in heart failure. Design. A retrospective chart review. Setting. Pediatric intensive care unit of a university-affiliated tertiary care hospital. Patients. Fourteen children in heart failure, secondary to dilated cardiomyopathy (n04), rejection (n06) and congenital heart disease (n04), managed with nesiritide while receiving two or more diuretics, two or more vasoactive medications, or increasing vasoactive or diuretic medications during the 12 h prior to nesiritide initiation. Interventions. None. Measurements and main results. The mean arterial pressure, heart rate, and central venous pressure did not change significantly following the administration of nesiritide. Fluid balance and urine output demonstrated suggestive, but non-significant, improvements (p00.13 and 0.1, respectively). One patient experienced an episode of hypotension leading to the discontinuation of nesiritide. No other adverse events were noted. Three of 14 patients exhibited increases in serum creatinine of more than 0.5 mg/dl, including two patients whose creatinine rose above 2 mg/dl or doubled from baseline. Nine of 14 (64%) patients survived to hospital discharge. Conclusion. Nesiritide is well tolerated in pediatric patients who require high-dose or escalating doses of vasoactive or diuretic medications. The use of nesiritide in this population is not associated with significant changes in hemodynamic parameters and may improve fluid mobilization. A prospective study is necessary to rigorously examine its efficacy and safety.