Use of nesiritide in critically ill children with biventricular dysfunction suffering from oliguria despite standard heart-failure management

Current and Future Drug and Device Therapies for Pediatric Heart Failure Patients: Potential Lessons from Adult Trials

This review discusses the potential drug and device therapies for pediatric heart failure (HF) due to reduced systolic function. It is important to realize that most drugs that are used in pediatric HF are extrapolated from adult cardiology practices or consensus guidelines based on expert opinion rather than on evidence from controlled clinical trials. It is difficult to conclude whether the drugs that are well established in adult HF trials are also beneficial for children because of tremendous heterogeneity in the mechanism of HF in children and variations in the pharmacokinetics and pharmacodynamics of drugs from birth to adolescence. The lessons learned from adult trials can guide pediatric cardiologists to design clinical trials of the newer drugs that are in the pipeline to study their efficacy and safety in children with HF. This paper's focus is that the reader should specifically think through the pathophysiological mechanism of HF and the mode of action of drugs for the selection of appropriate pharmacotherapy. We review the drug and device trials in adults with HF to highlight the knowledge gap that exists in the pediatric HF population.

Nesiritide in patients with acute myocardial infarction and heart failure: a meta-analysis

Objective

This meta-analysis evaluated the efficacy and safety of nesiritide in patients with acute myocardial infarction (AMI) and heart failure.

Methods

PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched from inception through December 2018. Studies including patients with AMI and heart failure who received nesiritide were identified.

Results

Ten trials involving 870 participants were included in this meta-analysis. Nesiritide treatment significantly increased left ventricular ejection fraction, cardiac index, and 24- and 72-hour urine volumes. Additionally, pulmonary capillary wedge pressure, right atrial pressure, and brain natriuretic peptide and N-terminal brain natriuretic peptide levels were significantly decreased in patients treated with nesiritide compared with those treated with control drugs. However, patients treated with nesiritide did not have an increased risk of mortality compared with those treated with control drugs. There were no differences between the two groups with respect to heart rate or the risk of readmission, hypotension, or renal dysfunction.

Conclusions

Nesiritide appears to be safe for patients with AMI and heart failure, and it improves global cardiac and systemic function.