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The natriuretic peptide system plays an active role in the regulation of fluid balance and systemic vascular resistance. Advances in recombinant technology have provided the opportunity for the exogenous administration of a recombinant form of B-type natriuretic peptide (nesiritide). To date, reports of its use in the pediatric population are limited, with limited information regarding its use in patients less than 12 months of age. We retrospectively reviewed our experience with nesiritide in infants less than 12 months of age to determine its efficacy and adverse effect profile. The study cohort included 22 patients, ranging in age from 4 days to 12 months. The starting dose of the nesiritide infusion ranged from 0.01 to 0.05 μg/kg/min (0.015 ± 0.01μg/kg/min) and was administered for a total of 3 to 264 hours (85.2 ± 75.0 hours). Nesiritide resulted in a significant increase in urine output even in the face of decreased fluid intake. Mean urine output increased from 3.1 ± 2.5 mL/kg/h before nesiritide to 5.7 ± 4.5 mL/kg/h (P = .03) during the initial 24 hours after starting the infusion. Fluid intake before and after the infusion were 126 ± 60 mL/kg/d and 108 ± 56 mL/kg/d, respectively. There were no statistically or clinically significant changes in hemodynamic parameters (heart rate, blood pressure, and central venous pressure) during the nesiritide infusion. No change in electrolytes, blood urea nitrogen, and creatinine were noted. No adverse effects of the nesiritide infusion were noted. No infusion was stopped due to adverse effects. These data suggest that nesiritide is a safe method of improving urine output in pediatrics patients less than 12 months of age and that the adverse effect profile does not appear to be different than that reported in older children.