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Randomized, double-blind, controlled trial of long-term diuretic therapy for bronchopulmonary dysplasia
S G Albersheim1, A J Solimano, A K Sharma
1Department of Pediatrics, University of British Columbia, Vancouver, Canada.
Insights
Continuous diuretic therapy with hydrochlorothiazide and spironolactone improved survival rates in premature infants with severe bronchopulmonary dysplasia. This treatment also enhanced respiratory system compliance, suggesting a better outcome for these vulnerable patients.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Pharmacology
Background:
- Bronchopulmonary dysplasia (BPD) is a chronic lung disease affecting premature infants.
- Severe BPD often requires mechanical ventilation and supplemental oxygen.
- Limited therapeutic options exist to improve outcomes in infants with severe BPD.
Purpose of the Study:
- To evaluate the effects of continuous hydrochlorothiazide and spironolactone therapy on pulmonary function and clinical outcomes in premature infants with severe BPD.
- To assess the impact of diuretic therapy on survival, hospital stay, ventilator days, and respiratory system compliance.
Main Methods:
- A randomized, double-blind, controlled trial was conducted with 34 premature infants diagnosed with severe BPD.
- Infants received either continuous hydrochlorothiazide and spironolactone or a placebo.
- Pulmonary function, ventilatory measurements, and anthropometrics were assessed at baseline and at 1, 4, and 8 weeks. Survival to discharge was a primary outcome.
Main Results:
- The proportion of infants alive at discharge was significantly higher in the treatment group (84%) compared to the placebo group (47%) (p=0.05).
- Total respiratory system compliance at 4 weeks was significantly improved in the treatment group (0.61 ± 0.18) versus the placebo group (0.45 ± 0.13) (p=0.016).
- No significant differences were observed in total hospital days or total ventilator days between groups.
Conclusions:
- Continuous long-term diuretic therapy with hydrochlorothiazide and spironolactone appears to improve clinical outcomes, including survival, in premature infants with severe bronchopulmonary dysplasia.
- The observed improvement in respiratory system compliance suggests a beneficial effect on lung function.
- Further research may explore optimal diuretic regimens for managing BPD.
Abstract:
The effects of continuous therapy with hydrochlorothiazide and spironolactone on pulmonary function in 34 premature infants with severe bronchopulmonary dysplasia were assessed in a randomized double-blind controlled trial. Subjects were greater than or equal to 30 days old, were supported by mechanical ventilation in greater than or equal to 30% oxygen, and had radiographic evidence of bronchopulmonary dysplasia. The treatment group (n = 19) and the placebo group (n = 15) were similar in all respects except for distribution of gender. Anthropometrics, ventilatory measurements, and the results of pulmonary function tests were evaluated at study entry and at 1, 4, and 8 weeks into therapy. Poststudy chest radiographs were compared with those obtained before the study. The proportion of infants alive at discharge was significantly increased (84%) in the treatment group compared with the placebo group (47%) (p = 0.05). There were no statistically significant differences in total hospital days or in total ventilator days. Total respiratory system compliance at 4 weeks was higher in the treatment group (0.61 +/- 0.18) than in the placebo group (0.45 +/- 0.13) (p = 0.016). No difference in outcome was detected between male and female infants in the treatment group. These results suggest that long-term diuretic therapy improves outcome in infants with bronchopulmonary dysplasia.