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The Use of Nesiritide in Children With Congenital Heart Disease

Bronicki, Ronald A. MD, FCCM, FACC1; Domico, Michele MD2; Checchia, Paul A. MD, FCCM, FACC1; Kennedy, Curtis E. MD3; Akcan-Arikan, Ayse MD4

Pediatric Critical Care Medicine: February 2017 - Volume 18 - Issue 2 - p 151-158
doi: 10.1097/PCC.0000000000000996
Cardiac Intensive Care
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Objective: We evaluated the use of nesiritide in children with critical congenital heart disease, pulmonary congestion, and inadequate urine output despite conventional diuretic therapy.

Design: We conducted a retrospective analysis of 26 consecutive patients, comprising 37 infusions occurring during separate hospitalizations. Hemodynamic variables, urine output, and serum creatinine levels were monitored prior to and throughout the duration of therapy with nesiritide. In addition, the stage of acute kidney injury was determined prior to and throughout the duration of the therapy using a standardized definition of acute kidney injury—The Kidney Disease: Improving Global Outcomes criteria.

Setting: Cardiac ICU.

Patients: Pediatric patients with critical congenital heart disease, pulmonary congestion, and inadequate urinary output despite diuretic therapy.

Intervention: Nesiritide infusion.

Measurements and Main Results: The use of nesiritide was associated with a significant decrease in the central venous pressure and heart rate with a trend toward a significant increase in urine output. During the course of therapy with nesiritide, the serum creatinine and stage of acute kidney injury decreased significantly. The decrease in stage of acute kidney injury became significant by day 4 (p = 0.006) and became more significant with time (last day of therapy compared with baseline; p < 0.001). During 12 of the 37 infusions, the stage of acute kidney injury decreased by two or more (p < 0.001).

Conclusions: Nesiritide had a favorable impact on hemodynamics and urine output in children with critical congenital heart disease and pulmonary congestion, and there was no worsening of renal function.

1Section of Pediatric Critical Care Medicine and Cardiology, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX.

2Section of Pediatric Critical Care Medicine, Children’s Hospital of Orange County, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA.

3Section of Pediatric Critical Care Medicine, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX.

4Section of Pediatric Critical Care Medicine and Nephrology, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/pccmjournal).

Dr. Domico disclosed receiving a grant from ELSO in 2015 for unrelated work. Dr. Akcan-Arikan received a grant from Baxter Healthcare. The remaining authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: Bronicki@bcm.edu

Copyright © 2017 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies