Safety and Efficacy of Nesiritide in Pediatric Heart Failure

John Jefferies, Jack F. Price, Susan W. Denfield, Anthony C. Chang, William J. Dreyer, Colin J. McMahon, Michelle A. Grenier, Sarah K. Clunie, Anne Thomas, Brady S. Moffett, Tiffany S. Wann, E. O.Brian Smith, Jeffrey Towbin

Research output: Contribution to journalArticle

36 Citations (Scopus)

Abstract

Background: We hypothesized that recombinant B-type natriuretic peptide (BNP) (nesiritide) could improve urine output and neurohormonal markers of heart failure without worsening renal function in pediatric patients. Methods and Results: We analyzed our experience involving 140 nesiritide infusions in 63 consecutive children. Serum levels of BNP and electrolytes were measured before and after therapy. Dosing was begun at 0.01 mcg·kg·min without a bolus and titrated to a maximum of 0.03 mcg·kg·min, in 0.005-mcg·kg·min increments. Blood pressure, heart rate, and heart rhythm were monitored. In a substudy, 20 patients with decompensated cardiomyopathy-related heart failure received 72 hours of nesiritide with prospective assessment of aldosterone, norepinephrine, plasma renin, and endothelin-1 levels before and after therapy. The heart rate decreased significantly (P = .001). Urine output increased significantly on Days 1 and 3 (P ≤ .001 and .004, respectively). The mean serum creatinine level decreased from 1.135 to 1.007 mg/dL (P ≤ .001). In the substudy, aldosterone levels decreased from 37.5 ± 57.1 to 20.5 ± 41.9 ng/dL (P = .005). Plasma renin, norepinephrine, and endothelin-1 levels decreased nonsignificantly. Two infusions were discontinued because of hypotension. Conclusions: Nesiritide safely treated decompensated heart failure in children. Increased urine output reflected improving renal function. Improved neurohormonal markers were seen after 72 hours of therapy, and complications were uncommon.

Original languageEnglish (US)
Pages (from-to)541-548
Number of pages8
JournalJournal of Cardiac Failure
Volume13
Issue number7
DOIs
StatePublished - Sep 1 2007
Externally publishedYes

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Brain Natriuretic Peptide
Heart Failure
Pediatrics
Safety
Urine
Endothelin-1
Aldosterone
Renin
Norepinephrine
Heart Rate
Kidney
Serum
Cardiomyopathies
Hypotension
Electrolytes
Creatinine
Therapeutics
Blood Pressure

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Safety and Efficacy of Nesiritide in Pediatric Heart Failure. / Jefferies, John; Price, Jack F.; Denfield, Susan W.; Chang, Anthony C.; Dreyer, William J.; McMahon, Colin J.; Grenier, Michelle A.; Clunie, Sarah K.; Thomas, Anne; Moffett, Brady S.; Wann, Tiffany S.; Smith, E. O.Brian; Towbin, Jeffrey.

In: Journal of Cardiac Failure, Vol. 13, No. 7, 01.09.2007, p. 541-548.

Research output: Contribution to journalArticle

Jefferies, J, Price, JF, Denfield, SW, Chang, AC, Dreyer, WJ, McMahon, CJ, Grenier, MA, Clunie, SK, Thomas, A, Moffett, BS, Wann, TS, Smith, EOB & Towbin, J 2007, 'Safety and Efficacy of Nesiritide in Pediatric Heart Failure', Journal of Cardiac Failure, vol. 13, no. 7, pp. 541-548. https://doi.org/10.1016/j.cardfail.2007.04.005
Jefferies, John ; Price, Jack F. ; Denfield, Susan W. ; Chang, Anthony C. ; Dreyer, William J. ; McMahon, Colin J. ; Grenier, Michelle A. ; Clunie, Sarah K. ; Thomas, Anne ; Moffett, Brady S. ; Wann, Tiffany S. ; Smith, E. O.Brian ; Towbin, Jeffrey. / Safety and Efficacy of Nesiritide in Pediatric Heart Failure. In: Journal of Cardiac Failure. 2007 ; Vol. 13, No. 7. pp. 541-548.
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AU - Jefferies, John

AU - Price, Jack F.

AU - Denfield, Susan W.

AU - Chang, Anthony C.

AU - Dreyer, William J.

AU - McMahon, Colin J.

AU - Grenier, Michelle A.

AU - Clunie, Sarah K.

AU - Thomas, Anne

AU - Moffett, Brady S.

AU - Wann, Tiffany S.

AU - Smith, E. O.Brian

AU - Towbin, Jeffrey

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N2 - Background: We hypothesized that recombinant B-type natriuretic peptide (BNP) (nesiritide) could improve urine output and neurohormonal markers of heart failure without worsening renal function in pediatric patients. Methods and Results: We analyzed our experience involving 140 nesiritide infusions in 63 consecutive children. Serum levels of BNP and electrolytes were measured before and after therapy. Dosing was begun at 0.01 mcg·kg·min without a bolus and titrated to a maximum of 0.03 mcg·kg·min, in 0.005-mcg·kg·min increments. Blood pressure, heart rate, and heart rhythm were monitored. In a substudy, 20 patients with decompensated cardiomyopathy-related heart failure received 72 hours of nesiritide with prospective assessment of aldosterone, norepinephrine, plasma renin, and endothelin-1 levels before and after therapy. The heart rate decreased significantly (P = .001). Urine output increased significantly on Days 1 and 3 (P ≤ .001 and .004, respectively). The mean serum creatinine level decreased from 1.135 to 1.007 mg/dL (P ≤ .001). In the substudy, aldosterone levels decreased from 37.5 ± 57.1 to 20.5 ± 41.9 ng/dL (P = .005). Plasma renin, norepinephrine, and endothelin-1 levels decreased nonsignificantly. Two infusions were discontinued because of hypotension. Conclusions: Nesiritide safely treated decompensated heart failure in children. Increased urine output reflected improving renal function. Improved neurohormonal markers were seen after 72 hours of therapy, and complications were uncommon.

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