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Meta-Analysis
. 2011 Sep 7;2011(9):CD001817.
doi: 10.1002/14651858.CD001817.pub2.

Diuretics acting on the distal renal tubule for preterm infants with (or developing) chronic lung disease

Audra Stewart  1 , Luc P Brion, Iris Ambrosio-Perez
Affiliations
Meta-Analysis

Diuretics acting on the distal renal tubule for preterm infants with (or developing) chronic lung disease

Audra Stewart et al. Cochrane Database Syst Rev. .

Abstract

Background: Lung disease in preterm infants is often complicated with lung edema.

Objectives: To assess the risks and benefits of diuretics acting on distal segments of the renal tubule (distal diuretics) in preterm infants with or developing chronic lung disease (CLD).

Search strategy: The standard method of the Cochrane Neonatal Review Group were used. Initially, MEDLINE (1966 to November 2001), EMBASE (1974 to November 2001) and the Cochrane Controlled Trials Register (CENTRAL,The Cochrane Library, Issue 4, 2001) were searched. In addition, several abstract books of national and international American and European Societies were hand searched. Updated searches in April 2003, April 2007, and December 2010 did not yield any additional trials.

Selection criteria: Included in this analysis are trials in which preterm infants with or developing CLD and at least five days of age were randomly allocated to receive a diuretic acting on the distal renal tubule. Eligible studies needed to assess at least one of the outcome variables defined a priori for this systematic review.

Data collection and analysis: The standard method for the Cochrane Collaboration described in the Cochrane Collaboration Handbook were used. Two investigators extracted, assessed and coded separately all data for each study. Any disagreement was resolved by discussion. Parallel and cross-over trials were combined. Whenever possible, baseline and final outcome data measured on a continuous scale was transformed into change scores using Follmann's formula.

Main results: Of the six studies fulfilling entry criteria, most focused on pathophysiological parameters and did not assess effects on important clinical outcomes defined in this review, or the potential complications of diuretic therapy.In preterm infants > 3 weeks of age with CLD, a four week treatment with thiazide and spironolactone improved lung compliance and reduced the need for furosemide. A single study showed thiazide and spironolactone decreased the risk of death and tended to decrease the risk for remaining intubated after eight weeks in infants who did not have access to corticosteroids, bronchodilators or aminophylline.

Authors' conclusions: In preterm infants > 3 weeks of age with CLD, acute and chronic administration of distal diuretics improve pulmonary mechanics. However, positive effects should be interpreted with caution as the numbers of patients studied are small in surprisingly few randomized controlled trials.

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Conflict of interest statement

None

Figures

1.1
1.1. Analysis
Comparison 1 Thiazide with spironolactone versus control, Outcome 1 Lack of extubation after 8 weeks of treatment.
1.2
1.2. Analysis
Comparison 1 Thiazide with spironolactone versus control, Outcome 2 Change in % inspiratory O2 after 4 wk.
1.3
1.3. Analysis
Comparison 1 Thiazide with spironolactone versus control, Outcome 3 Duration of O2 supplementation (days).
1.4
1.4. Analysis
Comparison 1 Thiazide with spironolactone versus control, Outcome 4 Length of hospital stay (days) after study entry.
1.5
1.5. Analysis
Comparison 1 Thiazide with spironolactone versus control, Outcome 5 Rehospitalization(s) for respiratory deterioration.
1.6
1.6. Analysis
Comparison 1 Thiazide with spironolactone versus control, Outcome 6 Death before discharge.
1.7
1.7. Analysis
Comparison 1 Thiazide with spironolactone versus control, Outcome 7 Death before discharge in males (intubated patients).
1.8
1.8. Analysis
Comparison 1 Thiazide with spironolactone versus control, Outcome 8 Change in compliance (ml/cm H2O/kg), non intubated patients.
1.9
1.9. Analysis
Comparison 1 Thiazide with spironolactone versus control, Outcome 9 Compliance (ml/cm H2O/kg), intubated patients.
1.10
1.10. Analysis
Comparison 1 Thiazide with spironolactone versus control, Outcome 10 Compliance (ml/cm H2O/kg), all patients.
1.11
1.11. Analysis
Comparison 1 Thiazide with spironolactone versus control, Outcome 11 Change in resistance (cm/L/sec), non intubated patients.
1.12
1.12. Analysis
Comparison 1 Thiazide with spironolactone versus control, Outcome 12 Resistance (cm/L/sec), intubated patients.
1.13
1.13. Analysis
Comparison 1 Thiazide with spironolactone versus control, Outcome 13 Resistance (cm/L/sec), all patients.
1.14
1.14. Analysis
Comparison 1 Thiazide with spironolactone versus control, Outcome 14 Change in maximum expiratory flow at FRC (TGV/sec), non intubated patients.
1.15
1.15. Analysis
Comparison 1 Thiazide with spironolactone versus control, Outcome 15 Lack of improvement in chest radiogram after 8 weeks.
1.16
1.16. Analysis
Comparison 1 Thiazide with spironolactone versus control, Outcome 16 Weight gain in 8 weeks.
1.17
1.17. Analysis
Comparison 1 Thiazide with spironolactone versus control, Outcome 17 Need for at least 1 dose of furosemide during the study.
1.18
1.18. Analysis
Comparison 1 Thiazide with spironolactone versus control, Outcome 18 Need for at least 10‐12 doses of furosemide during the study.
1.19
1.19. Analysis
Comparison 1 Thiazide with spironolactone versus control, Outcome 19 Total dose of furosemide required in 8 weeks (mg/kg).
1.20
1.20. Analysis
Comparison 1 Thiazide with spironolactone versus control, Outcome 20 Severe electrolyte anomaly requiring withdrawal from the study.
1.21
1.21. Analysis
Comparison 1 Thiazide with spironolactone versus control, Outcome 21 Need for Na or K supplementation.
1.22
1.22. Analysis
Comparison 1 Thiazide with spironolactone versus control, Outcome 22 Calcium excretion (%).
1.23
1.23. Analysis
Comparison 1 Thiazide with spironolactone versus control, Outcome 23 Nephrocalcinosis.
1.24
1.24. Analysis
Comparison 1 Thiazide with spironolactone versus control, Outcome 24 Hearing loss.
1.25
1.25. Analysis
Comparison 1 Thiazide with spironolactone versus control, Outcome 25 Weight (Kg) at one year postterm corrected age.
1.26
1.26. Analysis
Comparison 1 Thiazide with spironolactone versus control, Outcome 26 Length (cm) at one year postterm corrected age.
2.1
2.1. Analysis
Comparison 2 Thiazide with spironolactone (Treatment) vs thiazide alone (Control), Outcome 1 Lack of extubation after 2 wk.
2.2
2.2. Analysis
Comparison 2 Thiazide with spironolactone (Treatment) vs thiazide alone (Control), Outcome 2 Change in % O2 after 2 wk.
2.3
2.3. Analysis
Comparison 2 Thiazide with spironolactone (Treatment) vs thiazide alone (Control), Outcome 3 Change in compliance (ml/cm H2O/kg) after 2 wk.
2.4
2.4. Analysis
Comparison 2 Thiazide with spironolactone (Treatment) vs thiazide alone (Control), Outcome 4 Change in resistance (cm/L/sec) after 2 wk.
2.5
2.5. Analysis
Comparison 2 Thiazide with spironolactone (Treatment) vs thiazide alone (Control), Outcome 5 Change in tidal volume (ml) after 2 wk.
2.6
2.6. Analysis
Comparison 2 Thiazide with spironolactone (Treatment) vs thiazide alone (Control), Outcome 6 Na supplement required.
2.7
2.7. Analysis
Comparison 2 Thiazide with spironolactone (Treatment) vs thiazide alone (Control), Outcome 7 K supplement required.
2.8
2.8. Analysis
Comparison 2 Thiazide with spironolactone (Treatment) vs thiazide alone (Control), Outcome 8 Na or K supplement required.
3.1
3.1. Analysis
Comparison 3 Furosemide and metolazone (Treatment) versus furosemide only (Control), Outcome 1 Change in plasma volume (ml/kg) after 4 days of therapy.
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Update of

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References to other published versions of this review

Brion 1999
    1. Brion LP, Primhak RA, Ambrosio‐Perez I. Diuretics acting on the distal renal tubule for preterm infants with (or developing) chronic lung disease. Cochrane Database of Systematic Reviews 1999, Issue 3. [DOI: 10.1002/14651858.CD001817] - DOI - PubMed
Brion 2000
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