Nesiritide improves urine output in severely ill pediatric patients awaiting heart transplantation without severe hypotension

Abstract

Background: Nesiritide (synthetic B-Natriuretic Peptide) has been shown to improve symptoms and hospitalization in adult patients with severe heart failure via a variety of mechanisms including enhanced diuresis. The major side effect precluding use is hypotension. This medication has not been evaluated in pediatric patients. The objective of this study is to review the use of nesiritide in a severely ill group of pediatric patients.Methods: This study reviews 10 uses of nesiritide in seven pediatric patients (ages 20 35 months old all but one less than 18 months old) who were awaiting cardiac transplantation due to severe congenital heart disease (6) or dilated cardiomyopathy (1). All patients were classified as Status IA on multiple inotrope infusions and diuretics. The study evaluated the effects of nesiritide on blood pressure and urine output values from the day prior to infusion to the final day of the infusion. All values are presented as mean S.D. with Student’s t-testing for statistical significance. Results: Nesiritide was infused for a 10.6 4.1 days at doses of 0.005 to 0.02mcg/kg/min. In one use, the infusionwas discontinued due to concern of hypotension (no significant change from the day prior to infusion on retrospective review). This patient’s infusion was resumed in 2 days. Infusions were continued until subjective patient improvement or cardiac transplant. Urine output (ml/kg/hr) improved by 24% (p 0.05) from preto duringnesiritide (pre 2.6 1.3 vs. during 3.6 1.6). Total urine output (ml) improved by 22% (p 0.05). The figure shows urine output changes with each infusion. There were no changes (p NS) in daily highest and lowest systolic blood pressure related to nesiritide infusion (pre high SBP 102 14 mmHg vs. post high 101 10; pre low SBP 78 11 vs. post low 74 10). Five of the seven patients received cardiac transplantation while two others clinically improved enough to discontinue nesiritide. No other adverse effects of nesiritide were noted. Conclusion: Nesiritide improves urine output without significant hypotension or other adverse effects in severely ill pediatric patients.