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Meta-Analysis
. 2011 Dec 7;2011(12):CD001454.
doi: 10.1002/14651858.CD001454.pub3.

Diuretics for respiratory distress syndrome in preterm infants

Audra Stewart  1 , Luc P Brion, Roger Soll
Affiliations
Meta-Analysis

Diuretics for respiratory distress syndrome in preterm infants

Audra Stewart et al. Cochrane Database Syst Rev. .

Abstract

Background: Lung edema may complicate respiratory distress syndrome (RDS) in preterm infants.

Objectives: The aim of this review was to assess the risks and benefits of diuretic administration in preterm infants with RDS.

Search methods: The standard search method of the Cochrane Neonatal Review Group was used. The Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library), MEDLINE and EMBASE were searched. These searches were updated in April 2003, March 2007, January 2011. In addition, the abstract books of the American Thoracic Society and Society for Pediatric Research were searched. MEDLINE and CENTRAL search was conducted using the keyword "Respiratory Distress Syndrome" alone, to find studies of medications recently classified as diuretics, such as theophylline. In addition, EMBASE, controlled-trials.com and clinicaltrials.gov searches were completed in January 2011. MEDLINE search updated to August 2011.

Selection criteria: Trials were included in which preterm infants with RDS and less than five days of age were randomly allocated to diuretic administration. Of those trials, studies were only included in which at least one of the following outcomes measures was evaluated: mortality, patent ductus arteriosus, hypovolemic shock, intraventricular hemorrhage, renal failure, duration of oxygen supplementation, duration of mechanical ventilation, need for oxygen supplementation at 28 days of life, oxygen supplementation at 36 weeks of postmenstrual age (gestational age + postnatal age), length of stay, number of rehospitalizations during the first year of life, and neurodevelopmental outcome.

Data collection and analysis: The standard method for the Cochrane Collaboration, which is described in the Cochrane Collaboration Handbook, was used. Two investigators extracted, assessed and coded separately all data for each study. Any disagreement was resolved by discussion.

Main results: Seven studies met inclusion criteria. Six studies using furosemide were done before the current era of prenatal steroids, surfactant and fluid restriction. Furosemide administration had no long-term benefits. Furosemide-induced transient improvement in pulmonary function did not outweigh an increased risk for patent ductus arteriosus and for hemodynamic instability. In one recent study, theophylline had no long-term benefits. Theophylline significantly decreased the risk of oligoanuria and transiently increased renal function, but did not significantly affect renal function at discharge or other outcomes.

Authors' conclusions: There are no data to support routine administration of furosemide in preterm infants with RDS. Elective administration of furosemide to any patient with RDS should be carefully weighed against the risk of precipitating hypovolemia or developing a symptomatic patent ductus arteriosus. There are not enough data to support routine administration of low-dose theophylline in preterm infants with RDS.

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Conflict of interest statement

None

Figures

1.1
1.1. Analysis
Comparison 1 Routine diuretic administration versus placebo, no treatment or PRN diuretic administration, Outcome 1 Death.
1.2
1.2. Analysis
Comparison 1 Routine diuretic administration versus placebo, no treatment or PRN diuretic administration, Outcome 2 Clinically significant PDA.
1.3
1.3. Analysis
Comparison 1 Routine diuretic administration versus placebo, no treatment or PRN diuretic administration, Outcome 3 Hypovolemic shock.
1.4
1.4. Analysis
Comparison 1 Routine diuretic administration versus placebo, no treatment or PRN diuretic administration, Outcome 4 Change in plasma volume (ml/kg) from 48 to 96 hours of life.
1.5
1.5. Analysis
Comparison 1 Routine diuretic administration versus placebo, no treatment or PRN diuretic administration, Outcome 5 Change in cardiovascular stability index from 48 to 96 hours of life.
1.6
1.6. Analysis
Comparison 1 Routine diuretic administration versus placebo, no treatment or PRN diuretic administration, Outcome 6 Dobutamine infusion rate (micrograms/kg/min) at the end of treatment.
1.7
1.7. Analysis
Comparison 1 Routine diuretic administration versus placebo, no treatment or PRN diuretic administration, Outcome 7 Dopamine infusion rate (micrograms/kg/min) at the end of treatment.
1.8
1.8. Analysis
Comparison 1 Routine diuretic administration versus placebo, no treatment or PRN diuretic administration, Outcome 8 Change in colloid infusion rate (ml/kg/hour) at the end of treatment.
1.9
1.9. Analysis
Comparison 1 Routine diuretic administration versus placebo, no treatment or PRN diuretic administration, Outcome 9 Failure to extubate within 3 days after study entry.
1.10
1.10. Analysis
Comparison 1 Routine diuretic administration versus placebo, no treatment or PRN diuretic administration, Outcome 10 Change in peak inspiratory pressure (cm H2O) during treatment.
1.11
1.11. Analysis
Comparison 1 Routine diuretic administration versus placebo, no treatment or PRN diuretic administration, Outcome 11 Change in mean airway pressure (cm H2O) during treatment.
1.12
1.12. Analysis
Comparison 1 Routine diuretic administration versus placebo, no treatment or PRN diuretic administration, Outcome 12 Duration of mechanical ventilation (days).
1.13
1.13. Analysis
Comparison 1 Routine diuretic administration versus placebo, no treatment or PRN diuretic administration, Outcome 13 Change in FiO2 during treatment.
1.14
1.14. Analysis
Comparison 1 Routine diuretic administration versus placebo, no treatment or PRN diuretic administration, Outcome 14 Change in alveolar‐arterial O2 gradient (mm Hg) during treatment.
1.15
1.15. Analysis
Comparison 1 Routine diuretic administration versus placebo, no treatment or PRN diuretic administration, Outcome 15 BPD.
1.16
1.16. Analysis
Comparison 1 Routine diuretic administration versus placebo, no treatment or PRN diuretic administration, Outcome 16 Death or BPD.
1.17
1.17. Analysis
Comparison 1 Routine diuretic administration versus placebo, no treatment or PRN diuretic administration, Outcome 17 Duration of oxygen supplementation (days).
1.18
1.18. Analysis
Comparison 1 Routine diuretic administration versus placebo, no treatment or PRN diuretic administration, Outcome 18 IVH.
1.19
1.19. Analysis
Comparison 1 Routine diuretic administration versus placebo, no treatment or PRN diuretic administration, Outcome 19 Severe IVH (grade III or IV).
1.20
1.20. Analysis
Comparison 1 Routine diuretic administration versus placebo, no treatment or PRN diuretic administration, Outcome 20 Duration of hospitalization (days).
1.21
1.21. Analysis
Comparison 1 Routine diuretic administration versus placebo, no treatment or PRN diuretic administration, Outcome 21 Significant handicap at one year (major neurologic defect and/or MDI/PDI <50).
1.22
1.22. Analysis
Comparison 1 Routine diuretic administration versus placebo, no treatment or PRN diuretic administration, Outcome 22 Oligoanuria (urine output < 1 ml/kg/hour).
1.23
1.23. Analysis
Comparison 1 Routine diuretic administration versus placebo, no treatment or PRN diuretic administration, Outcome 23 Hyponatremia (sodium < 130 mM/L).
1.24
1.24. Analysis
Comparison 1 Routine diuretic administration versus placebo, no treatment or PRN diuretic administration, Outcome 24 Hyperkalemia (potassium > 6.5 mM/L).
2.1
2.1. Analysis
Comparison 2 Routine diuretic administration versus placebo or no treatment, Outcome 1 Death.
2.2
2.2. Analysis
Comparison 2 Routine diuretic administration versus placebo or no treatment, Outcome 2 Clinically significant PDA.
2.3
2.3. Analysis
Comparison 2 Routine diuretic administration versus placebo or no treatment, Outcome 3 Hypovolemic shock.
2.4
2.4. Analysis
Comparison 2 Routine diuretic administration versus placebo or no treatment, Outcome 4 Failure to extubate within 3 days after study entry.
2.5
2.5. Analysis
Comparison 2 Routine diuretic administration versus placebo or no treatment, Outcome 5 Change in peak inspiratory pressure (cm H2O) during treatment.
2.6
2.6. Analysis
Comparison 2 Routine diuretic administration versus placebo or no treatment, Outcome 6 Change in mean airway pressure (cm H2O) during treatment.
2.7
2.7. Analysis
Comparison 2 Routine diuretic administration versus placebo or no treatment, Outcome 7 Duration of mechanical ventilation (days).
2.8
2.8. Analysis
Comparison 2 Routine diuretic administration versus placebo or no treatment, Outcome 8 Change in FiO2 during treatment.
2.9
2.9. Analysis
Comparison 2 Routine diuretic administration versus placebo or no treatment, Outcome 9 Change in alveolar‐arterial O2 gradient (mm Hg) during treatment.
2.10
2.10. Analysis
Comparison 2 Routine diuretic administration versus placebo or no treatment, Outcome 10 BPD.
2.11
2.11. Analysis
Comparison 2 Routine diuretic administration versus placebo or no treatment, Outcome 11 Death or BPD.
2.12
2.12. Analysis
Comparison 2 Routine diuretic administration versus placebo or no treatment, Outcome 12 Duration of oxygen supplementation (days).
2.13
2.13. Analysis
Comparison 2 Routine diuretic administration versus placebo or no treatment, Outcome 13 IVH.
2.14
2.14. Analysis
Comparison 2 Routine diuretic administration versus placebo or no treatment, Outcome 14 Severe IVH (grade III or IV).
2.15
2.15. Analysis
Comparison 2 Routine diuretic administration versus placebo or no treatment, Outcome 15 Duration of hospitalization (days).
2.16
2.16. Analysis
Comparison 2 Routine diuretic administration versus placebo or no treatment, Outcome 16 Significant handicap at one year (major neurologic defect and/or MDI/PDI <50).
2.17
2.17. Analysis
Comparison 2 Routine diuretic administration versus placebo or no treatment, Outcome 17 Oligoanuria (urine output < 1 ml/kg/hour).
2.18
2.18. Analysis
Comparison 2 Routine diuretic administration versus placebo or no treatment, Outcome 18 Hyponatremia (sodium < 130 mM/L).
2.19
2.19. Analysis
Comparison 2 Routine diuretic administration versus placebo or no treatment, Outcome 19 Hyperkalemia (potassium > 6.5 mM/L).
3.1
3.1. Analysis
Comparison 3 PRN furosemide versus PRN chlorothiazide, Outcome 1 Death.
3.2
3.2. Analysis
Comparison 3 PRN furosemide versus PRN chlorothiazide, Outcome 2 Clinical diagnosis of PDA during the study.
3.3
3.3. Analysis
Comparison 3 PRN furosemide versus PRN chlorothiazide, Outcome 3 Clinical diagnosis of PDA (during the study or later).
3.4
3.4. Analysis
Comparison 3 PRN furosemide versus PRN chlorothiazide, Outcome 4 BPD.
3.5
3.5. Analysis
Comparison 3 PRN furosemide versus PRN chlorothiazide, Outcome 5 Death or BPD.
3.6
3.6. Analysis
Comparison 3 PRN furosemide versus PRN chlorothiazide, Outcome 6 IVH.
3.7
3.7. Analysis
Comparison 3 PRN furosemide versus PRN chlorothiazide, Outcome 7 Duration of mechanical ventilation in survivors (days).
3.8
3.8. Analysis
Comparison 3 PRN furosemide versus PRN chlorothiazide, Outcome 8 Duration of hospitalization (days).
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Update of

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References to other published versions of this review

Brion 1999
    1. Brion LP, Soll RF. Diuretics for respiratory distress syndrome in preterm infants. Cochrane Database of Systematic Reviews 1999, Issue 3. [DOI: 10.1002/14651858.CD001454.pub2] - DOI
Brion 2001
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Brion 2008
    1. Brion LP, Soll RF. Diuretics for respiratory distress syndrome in preterm infants.. Cochrane Database of Systematic Reviews 2008, Issue 1. [DOI: 10.1002/14651858.CD001454.pub2] - DOI - PubMed

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