Role of the renin-angiotensin-aldosterone system in the management of neonatal heart failure

Heart failure (HF) is common in the neonatal and pediatric populations. Despite advances in the management of HF, this disease carries significant mortality, morbidity, and socioeconomic burden. The renin-angiotensin-aldosterone system is a therapeutic target in the treatment of HF. In adults, significant advances have been made in the management of HF by targeting the renin-angiotensin-aldosterone system using angiotensin- converting enzyme inhibitors, angiotensin II receptor blockers, and mineralocorticoid receptor antagonists. Only angiotensin-converting enzyme inhibitors have been used in the pediatric population with HF. In this review, we provide an in-depth update on the pathophysiology of HF and discuss the potential future uses of newer and novel pharmacologic interventions in the management of HF in pediatric patients.