Several weeks ago, we had an infant patient who had received back-to-back heart transplants and was still in congestive heart failure with very poor diastolic function. He had failed extubation several times.

The baby's cardiologist was desperate to do something for this child and decided to try nesiritide (Natrecor). Because it's available in Canada by special release only, we were unable to find any information on it other than the package insert. I have Davis's Drug Guide on my PDA, and while it didn't have any information on pediatric administration, it was very helpful in understanding why we were trying it and what it was expected to do for him. He has since graduated from the PICU and will soon be discharged from hospital for the first time in his life.

Update - I saw this same little baby last week on his way back to the cardiac ward from the playroom. His mom was carrying him in her arms and she was just beaming. He will need to stay in the Edmonton area (he's from another province) for another several weeks for follow-up, as is protocol for transplant patients, but should soon be home and surrounded by the ones who love him.

Jan Fortier RN, Stollery Children's Hospital, Edmonton, Alberta, Canada