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. 2023 Oct;43(10):1288-1294.
doi: 10.1038/s41372-023-01742-0. Epub 2023 Aug 7.

Cardiopulmonary physiological effects of diuretic therapy in preterm infants with chronic pulmonary hypertension

Faith Zhu  1   2 , Daniel Ibarra Rios  3 , Sebastien Joye  4 , Michelle Baczynski  1 , Danielle Rios  5 , Regan E Giesinger  5 , Patrick J McNamara  5 , Amish Jain  6   7
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Cardiopulmonary physiological effects of diuretic therapy in preterm infants with chronic pulmonary hypertension

Faith Zhu et al. J Perinatol. 2023 Oct.

Abstract

Objective: Using targeted neonatal echocardiography (TNE) to examine cardiopulmonary physiological impact of diuretics in preterm infants with chronic pulmonary hypertension (cPH).

Study design: Retrospective study comparing TNE indices pre- and ≤2 weeks (post) of initiating diuretic therapy in infants born <32 weeks gestational age with cPH.

Results: Twenty-seven neonates with mean gestational age, birthweight and interval between pre-post diuretic TNE of 27.0 ± 2.8 weeks, 859 ± 294 grams, and 7.8 ± 3.0 days respectively were studied. Diuretics was associated with improvement in pulmonary vascular resistance [pulmonary artery acceleration time (PAAT); 34.27(9.76) vs. 40.24(11.10)ms, p = 0.01), right ventricular (RV) ejection time:PAAT ratio [5.92(1.66) vs. 4.83(1.14), p < 0.01)], RV fractional area change [41.6(9.8) vs. 46.4(6.5%), p = 0.03)] and left ventricular myocardial performance index [0.55(0.09) vs. 0.41(0.23), p < 0.01)]. Post-treatment, frequency of bidirectional/right-to-left inter-atrial shunts decreased significantly (24% vs. 4%, p = 0.05).

Conclusion: Primary diuretic treatment in neonates with cPH may result in improvement in PVR, RV and LV function and compliance.

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