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Loop Diuretics in Severe Bronchopulmonary Dysplasia: Cumulative Use and Associations with Mortality and Age at
Nicolas A Bamat1, Timothy D Nelin2, Eric C Eichenwald3
1Division of Neonatology and Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, PA.
Insights
Loop diuretic use varies widely in US hospitals for infants with severe bronchopulmonary dysplasia (BPD). This study found no significant differences in mortality or discharge age between high- and low-use centers, indicating a need for evidence-based guidelines.
Area of Science:
- Neonatology
- Pediatric Pulmonology
- Clinical Pharmacy
Background:
- Bronchopulmonary dysplasia (BPD) is a common complication in preterm infants.
- Loop diuretics are frequently used in managing severe BPD, but their optimal use and associated variations are not well-defined.
- Significant inter-center variability in clinical practice is a known issue in pediatric healthcare.
Purpose of the Study:
- To quantify the variation in loop diuretic use among US children's hospitals for infants with severe BPD.
- To compare mortality rates and age at discharge between infants treated at centers with low versus high loop diuretic use.
- To identify factors influencing loop diuretic prescribing patterns in this population.
Main Methods:
- Retrospective cohort study of preterm infants (<32 weeks gestational age) with severe BPD.
- Cumulative loop diuretic exposure was the primary outcome, defined as the proportion of days with use.
- Multivariable models adjusted for infant characteristics and compared outcomes between low-use and high-use centers.
Main Results:
- A substantial variation in loop diuretic use was observed across 43 centers, ranging from 7.3% to 49.4% of days, even after adjusting for case mix.
- No significant differences in mortality were found between low-use and high-use centers (aOR, 0.98; P=.92).
- Postmenstrual age at discharge was also similar between the groups (47.3 weeks vs. 47.4 weeks; P=.96).
Conclusions:
- Marked variation in loop diuretic use for severe BPD exists among US children's hospitals.
- This variability in practice did not correlate with differences in mortality or age at discharge.
- Further research is required to establish evidence-based guidelines for loop diuretic use in infants with severe BPD.
Objectives:
To measure between-center variation in loop diuretic use in infants developing severe bronchopulmonary dysplasia (BPD) in US children's hospitals, and to compare mortality and age at discharge between infants from low-use centers and infants from high-use centers.
Study Design:
We performed a retrospective cohort study of preterm infants at <32 weeks of gestational age with severe BPD. The primary outcome was cumulative loop diuretic use, defined as the proportion of days with exposure between admission and discharge. Infant characteristics associated with loop diuretic use at P < .10 were included in multivariable models to adjust for center differences in case mix. Hospitals were ranked from lowest to highest in adjusted use and dichotomized into low-use centers and high-use centers. We then compared mortality and postmenstrual age at discharge between the groups through multivariable analyses.
Results:
We identified 3252 subjects from 43 centers. Significant variation between centers remained despite adjustment for infant characteristics, with use present in an adjusted mean range of 7.3% to 49.4% of days (P < .0001). Mortality did not differ significantly between the 2 groups (aOR, 0.98; 95% CI, 0.62-1.53; P = .92), nor did postmenstrual age at discharge (marginal mean, 47.3 weeks [95% CI, 46.8-47.9 weeks] in the low-use group vs 47.4 weeks [95% CI, 46.9-47.9 weeks] in the high-use group; P = .96).
Conclusions:
A marked variation in loop diuretic use for infants developing severe BPD exists among US children's hospitals, without an observed difference in mortality or age at discharge. More research is needed to provide evidence-based guidance for this common exposure.
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