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Diuretics for respiratory distress syndrome in preterm infants
1Pediatrics, Division of Neonatology, Albert Einstein College of Medicine and Montefiore Medical Center, Weiler Hospital Room 725, 1825 Eastchester Road, Bronx, NY 10461, USA. brion@aecom.yu.edu
Insights
Diuretic use in preterm infants with respiratory distress syndrome (RDS) offers no long-term benefits and increases risks like patent ductus arteriosus. Routine diuretic administration is not supported by current evidence for these infants.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Clinical Pharmacology
Background:
- Lung edema is a common complication in preterm infants with respiratory distress syndrome (RDS).
- The use of diuretics to manage lung edema in this population is a clinical consideration.
Purpose of the Study:
- To systematically review the risks and benefits of administering diuretics to preterm infants diagnosed with RDS.
- To evaluate the impact of diuretic therapy on various clinical outcomes in this vulnerable patient group.
Main Methods:
- A systematic search of major databases (Medline, Embase, Cochrane Controlled Trials Register) was conducted.
- Included randomized controlled trials involving preterm infants (<5 days old) with RDS receiving diuretics.
- Key outcomes assessed included mortality, patent ductus arteriosus, renal function, and neurodevelopmental outcomes.
Main Results:
- Six studies met the inclusion criteria, with all trials predating current neonatal care advancements.
- Furosemide administration showed no long-term advantages and transient pulmonary function improvements were offset by increased risks.
- These risks included a higher incidence of patent ductus arteriosus and hemodynamic instability.
Conclusions:
- Current evidence does not support the routine use of diuretics in preterm infants with RDS.
- Elective diuretic administration, particularly furosemide, requires careful consideration of risks such as hypovolemia and symptomatic patent ductus arteriosus.
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 Strategy:
We used the standard search method of the Cochrane Neonatal Review Group. We searched Medline, Embase and the Cochrane Controlled Trials Register from the Cochrane Library, using the following keywords:
Selection Criteria:
We only included trials in which preterm infants with RDS and less than 5 days of age were randomly allocated to diuretic administration. Of those trials, we only included studies 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 postconceptional age (gestational age + postnatal age), length of stay, number of rehospitalizations during the first year of life, and neurodevelopmental outcome.
Data Collection And Analysis:
We used the standard method for the Cochrane Collaboration which is described in the Cochrane Collaboration Handbook. Two investigators extracted, assessed and coded separately all data for each study. Any disagreement was resolved by discussion.
Main Results:
Six studies met inclusion criteria. Studies available for this systematic review were all done before the current era of prenatal steroids, surfactant, indomethacin 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.
Reviewer'S Conclusions:
There are no current data to support routine diuretic administration in preterm infants with RDS. Elective administration of furosemide or any diuretic to any patient with RDS should be carefully weighed against the risk of precipitating hypovolemia. In addition, elective administration of furosemide should be weighed against the risk of developing a symptomatic patent ductus arteriosus.