Furosemide for packed red cell transfusion in preterm infants: a randomized controlled trial

Area of Science:

• Neonatal Medicine
• Pediatric Cardiology
• Pharmacology

Background:

• Preterm infants often require blood transfusions, posing risks of fluid overload and respiratory compromise.
• Furosemide is a diuretic sometimes used to manage fluid balance during transfusions.

Purpose of the Study:

• To evaluate the efficacy of furosemide in preventing cardiopulmonary complications during packed red blood cell transfusions in preterm infants.
• To assess the impact of furosemide on respiratory support needs (FiO2) and echocardiographic parameters.

Main Methods:

• A randomized, double-blind, placebo-controlled trial involving preterm infants receiving elective packed red blood cell transfusions.
• Infants received either intravenous furosemide (1 mg/kg) or normal saline placebo immediately before transfusion.
• Cardiopulmonary variables, including fraction of inspired oxygen (FiO2), were monitored pre- and post-transfusion.

Main Results:

• No significant differences in most cardiopulmonary variables were observed between the furosemide and placebo groups.
• A small, statistically significant increase in posttransfusion FiO2 was noted in the placebo group compared to the furosemide group.
• The absolute increase in FiO2 in the placebo group was from 0.27 to 0.29, considered clinically insignificant.

Conclusions:

• Routine use of furosemide during elective packed red blood cell transfusions in preterm infants provides minimal clinical benefit.
• The potential adverse effects of furosemide should be weighed against the prevention of a clinically insignificant rise in FiO2.