The effect of the first dose of captopril on blood pressure in infants in heart failure.

In a double-blind controlled study, six infants with congestive heart failure were given captopril to observe the effect on blood pressure. There was a significant fall in systolic (P less than 0.02) and diastolic (P less than 0.01) blood pressure at 90 minutes after the first dose. There was no correlation with plasma renin activity or plasma sodium concentration. The need to monitor blood pressure after introduction of captopril therapy for the treatment of heart failure in infants is demonstrated.

Captopril in treatment of infant heart failure: a preliminary report.

We have studied retrospectively 18 infants who have received captopril for treatment of severe heart failure due to left-to-right shunts with pulmonary hypertension. Captopril has been administered in doses of up to 3.5 mg/kg/day (mean 2.47 mg/kg/day). Maintenance treatment with digoxin and frusemide was continued but potassium-sparing diuretics were stopped in most patients. The mean period of assessment was 19 days before and 27 days after commencing captopril. The mean daily weight gain before captopril was -7 g and after its introduction was + 13 g (P less than 0.001). There were statistically significant (P less than 0.05) falls in mean heart rate and respiratory rate and rises in plasma sodium concentration and feeding score. Plasma urea concentration fell but this did not reach statistical significance. Two patients suffered hypotension after increments in captopril dosage and subsequently had a rise in plasma urea and creatinine values. This adverse reaction may be linked to the presence of hyponatraemia. This preliminary report shows captopril may be useful in the control of severe heart failure in infancy.

Plasma aldosterone and renin activity.

Eight infants had paired measurements of plasma aldosterone and plasma renin activity while being treated for congestive heart failure. There is parallelism with aldosterone and renin activity in the presence of a hyperactive renin-angiotensin-aldosterone system. Six patients had plasma renin activity and plasma aldosterone measured after commencing captopril and we have shown biochemical blockade of the renin-angiotensin-aldosterone system.

Plasma renin activity in infants with congenital heart disease.

Plasma renin activity was estimated in 11 infants with severe congestive heart failure. The infants had congenital heart disease with left to right shunts and were receiving diuretic treatment. Plasma renin activity was measured by radioimmunoassay of generated concentrations of angiotensin I. The mean (SD) plasma renin activity was 84 (21) ng angiotensin I/ml/hour, which is considerably above normal infant values. A hyperactive renin-angiotensin system may be detrimental in these patients. Angiotensin converting enzyme inhibitors may be of value in treating infants with severe congestive heart failure.

An unusual manifestation of staphylococcal lung infection.

An infant developed a rapidly progressive respiratory illness with cystic lesions on chest radiography. At thoracotomy there were multiple bullae on the surface of the lung. Staphylococcus aureus, of phage type 71, was isolated from the bullous fluid. We believe the lung disease was caused by an epidermolytic toxin.