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Clinical Trial
. 2018 Jun:197:42-47.e1.
doi: 10.1016/j.jpeds.2018.01.066. Epub 2018 Mar 26.

Acute Responses to Diuretic Therapy in Extremely Low Gestational Age Newborns: Results from the Prematurity and Respiratory Outcomes Program Cohort Study

Carol J Blaisdell  1 , James Troendle  2 , Anne Zajicek  3 ; Prematurity and Respiratory Outcomes Program
Collaborators, Affiliations
Clinical Trial

Acute Responses to Diuretic Therapy in Extremely Low Gestational Age Newborns: Results from the Prematurity and Respiratory Outcomes Program Cohort Study

Carol J Blaisdell et al. J Pediatr. 2018 Jun.

Abstract

Objective: To determine if daily respiratory status improved more in extremely low gestational age (GA) premature infants after diuretic exposure compared with those not exposed in modern neonatal intensive care units.

Study design: The Prematurity and Respiratory Outcomes Program (PROP) was a multicenter observational cohort study of 835 extremely premature infants, GAs of 230/7-286/7 weeks, enrolled in the first week of life from 13 US tertiary neonatal intensive care units. We analyzed the PROP study daily medication and respiratory support records of infants ≤34 weeks postmenstrual age. We determined whether there was a temporal association between the administration of diuretics and an acute change in respiratory status in premature infants in the neonatal intensive care unit, using an ordered categorical ranking of respiratory status.

Results: Infants in the diuretic exposed group of PROP were of lower mean GA and lower mean birth weight (P < .0001). Compared with infants unexposed to diuretics, the probability (adjusted for infant characteristics including GA, birth weight, sex, and respiratory status before receiving diuretics) that the exposed infants were on a higher level of respiratory support was significantly greater (OR, >1) for each day after the initial day of diuretic exposure.

Conclusions: Our analysis did not support the ability of diuretics to substantially improve the extremely premature infant's respiratory status. Further study of both safety and efficacy of diuretics in this setting are warranted.

Trial registration: Clinicaltrials.gov: NCT01435187.

Keywords: diuretic; prematurity; respiratory distress.

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Figures

Figure
Figure. Effect of Diuretic Exposure: Odds Ratio of Having More Respiratory Support Than Unexposed
Forest plot of the odds ratio of worse respiratory outcome (greater support) for exposed days 1–7 and >7 compared with unexposed days. Model adjusted for infant birth weight, infant gestational age at birth, infant race, infant sex, site, and multiplicity of birth, and accounts for respiratory status on the first day of exposure.
See this image and copyright information in PMC

Comment in

  • Reply.
    Blaisdell CJ, Troendle J, Zajicek A. Blaisdell CJ, et al. J Pediatr. 2018 Oct;201:298. doi: 10.1016/j.jpeds.2018.06.042. Epub 2018 Jul 13. J Pediatr. 2018. PMID: 30017340 No abstract available.
  • Diuretics in newborns born extremely premature: the jury is still out.
    Koumbourlis AC. Koumbourlis AC. J Pediatr. 2018 Oct;201:298. doi: 10.1016/j.jpeds.2018.06.040. Epub 2018 Jul 17. J Pediatr. 2018. PMID: 30029857 No abstract available.

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