[Effect of dexamethasone and spironolactone therapy on diuresis and creatine clearance in premature infants with a birth weight below 1,500 g]

Abstract

Background: The aim of the study was to examine the influence of dexamethasone and spironolactone on diuresis and creatinine clearance in 8-40 day old premature infants with a birth weight less than 1500 g.

Patients: 85 preterm infants were included in this study. Median birth weight was 1195 g (range 560-1495), mean gestational age was 28 (range 25-34) weeks. 31 infants were given dexamethasone if bronchopulmonary dysplasia was diagnosed and 32 infants received spironolactone. Indication for spironolactone was persistent ductus arteriosus or bronchopulmonary dysplasia.

Method: The multivariate variance analysis (MANOVA) was performed to investigate the influence of spironolactone and dexamethasone on diuresis and creatinine clearance. Additional influence of gestational age, postnatal age and fluid intake wa eliminated by the multivariate variance analysis.

Results: Spironolactone therapy resulted in no differences for diuresis and creatinine clearance. Dexamethasone therapy increased creatinine clearance (p < 0.05) and diuresis (p < 0.005).

Conclusions: Spironolactone is not very effective in the therapy of persistent ductus arteriosus and bronchopulmonary dysplasia. Diuresis and creatinine clearance are not increased. In conclusion spironolactone is more effective in clinical conditions associated with high circulating levels of aldosterone. Dexamethasone, on the other hand, has a high effect on diuresis and creatinine clearance. The pathomechanism for the increase of parameters studied is not completely understood.