Nesiritide Use Following Cardiac Surgery in Infants

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT00281671
Recruitment Status : Terminated (Slow patient enrollment.)
First Posted : January 25, 2006
Last Update Posted : January 29, 2009
Information provided by:
Boston Children’s Hospital

Brief Summary:
The purpose of this study is to determine the effects of nesiritide on urine output and hemodynamics following cardiopulmonary bypass in infants. Safety and pharmacokinetic data will also be obtained.

Condition or disease Intervention/treatment Phase
Heart Defects, Congenital Cardiopulmonary Bypass Drug: nesiritide Phase 1 Phase 2

Detailed Description:

Nesiritide, a recombinant human B-type natriuretic peptide, has vasodilatory, lusitropic and diuretic properties in healthy humans, and improves hemodynamics and symptoms in adults with decompensated congestive heart failure. Several retrospective case series suggest that nesiritide has beneficial effects on hemodynamics and urine output in adults and children following cardiac surgery.

The purpose of this prospective, randomized, double-blind, crossover study is to evaluate the effects of a continuous infusion of nesiritide on postoperative hemodynamics and urine output in infants with congenital heart disease who undergo cardiac surgery requiring cardiopulmonary bypass (CPB). Patients less than 1 year of age following cardiac surgery will be eligible for the study if they have received two conventional diuretics (furosemide and chlorothiazide) for at least 12 hours, yet are not effectively achieving a negative fluid balance, thus prohibiting sternal closure or tracheal extubation. Patients will be randomized to receive either a 10-hour infusion of nesiritide, a two hour washout period, followed by a 10-hour infusion of placebo, or this study drug sequence in reverse order. During the 24-hour study period, serial cardiac output measurements and BNP levels will be obtained, vital signs and intracardiac filling pressures will be recorded, and urine output will be measured.

Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 9 participants
Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Pilot Study of the Effects of Nesiritide on Hemodynamics and Urine Output Following Cardiopulmonary Bypass in Infants
Study Start Date : February 2006
Actual Primary Completion Date : October 2008
Actual Study Completion Date : October 2008

Resource links provided by the National Library of Medicine

Drug Information available for: Nesiritide

Arm Intervention/treatment
In this crossover pilot study, patients are randomly assigned to receive either nesiritide or placebo infusion for 10 hours, followed by a two hour washout period, and then the other study drug for 10 hours.
Drug: nesiritide
nesiritide 0.015 mcg/kg/hour x 10 hours
Other Name: Natrecor

Primary Outcome Measures :
  1. urine output [ Time Frame: 5 hours ]

Secondary Outcome Measures :
  1. Safety [ Time Frame: 48 hours ]
  2. urine output [ Time Frame: 10 hours ]
  3. cardiac index [ Time Frame: 6 horus ]

Information from the National Library of Medicine

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Ages Eligible for Study:   up to 1 Year   (Child)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • > 48 hours after cardiac surgery requiring cardiopulmonary bypass
  • < 1 year of age
  • Receiving chlorothiazide and furosemide for > 12 hours
  • Urine output < 4 cc/kg/hour, or fluid intake > output for 2 consecutive days
  • Receiving mechanical ventilation
  • Presence of body wall edema on CXR, defined as a radiologic index of > 2
  • Plan for > 24 hrs further diuresis before chest closure or extubation

Exclusion Criteria:

  • Age > 365 days at the time of enrollment
  • Corrected estimated gestational age < 35 weeks at the time of enrollment
  • Serum creatinine > 2.0 mg/dL at the time of enrollment
  • Significant hemodynamic instability at the time of enrollment
  • Lack of dedicated intravenous access for nesiritide infusion
  • Lack of arterial line for continuous blood pressure monitoring
  • Lack of a Foley catheter for continuous urine collection
  • Enrollment in another research study such that the outcomes of either study may be confounded by participation in this study, or such that the amount of blood drawn for research purposes becomes excessive.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT00281671

United States, Massachusetts
Children's Hospital Boston
Boston, Massachusetts, United States, 02115
Sponsors and Collaborators
Boston Children’s Hospital
Principal Investigator: John M Costello, MD Department of Cardiology, Children's Hospital Boston

Responsible Party: John M. Costello, MD MPH, Children's Hospital Boston Identifier: NCT00281671     History of Changes
Other Study ID Numbers: 05-12-160
First Posted: January 25, 2006    Key Record Dates
Last Update Posted: January 29, 2009
Last Verified: January 2009

Keywords provided by Boston Children’s Hospital:
Natriuretic Peptide, Brain
Heart Defects, Congenital
Cardiopulmonary Bypass

Additional relevant MeSH terms:
Congenital Abnormalities
Heart Defects, Congenital
Cardiovascular Abnormalities
Cardiovascular Diseases
Heart Diseases
Natriuretic Peptide, Brain
Natriuretic Agents
Physiological Effects of Drugs