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Diuretics for respiratory distress syndrome in preterm infants

Audra Stewart1, Luc P Brion, Roger Soll

  • 1Neonatal-Perinatal Medicine, University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Boulevard, Dallas, Texas, USA, 75390-9063.

The Cochrane Database of Systematic Reviews
|December 14, 2011
PubMed

Insights

Diuretics like furosemide do not benefit preterm infants with respiratory distress syndrome (RDS) long-term and increase risks. Theophylline also shows no long-term benefits for RDS in preterm infants.

Area of Science:

  • Neonatal Medicine
  • Pediatric Pulmonology
  • Clinical Pharmacology

Background:

  • Lung edema is a common complication of respiratory distress syndrome (RDS) in preterm infants.
  • Diuretic administration is sometimes used to manage fluid overload in these infants.

Purpose of the Study:

  • To evaluate the risks and benefits of using diuretics in preterm infants diagnosed with RDS.
  • To synthesize evidence from randomized controlled trials on diuretic use in neonatal RDS.

Main Methods:

  • Systematic review of randomized controlled trials (RCTs) identified through extensive database searches (CENTRAL, MEDLINE, EMBASE) and conference abstracts.
  • Inclusion criteria focused on preterm infants (<5 days old) with RDS, randomly assigned to diuretic treatment, with key outcome measures like mortality, patent ductus arteriosus, and renal function.
  • Data extraction and analysis followed Cochrane Collaboration standards, with independent review by two investigators.

Main Results:

  • Seven studies met the criteria; six evaluated furosemide, predating modern RDS management. Furosemide offered no sustained benefits and increased risks of patent ductus arteriosus and hemodynamic instability.
  • A recent study on theophylline showed no long-term advantages, although it transiently improved renal function and reduced oligoanuria without affecting renal function at discharge.

Conclusions:

  • Current evidence does not support the routine use of furosemide in preterm infants with RDS.
  • The potential risks of furosemide, including hypovolemia and symptomatic patent ductus arteriosus, necessitate careful consideration.
  • Insufficient data exist to recommend routine low-dose theophylline administration for preterm infants with RDS.
Abstract

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