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Diuretic therapy and acute kidney injury in preterm neonates and infants
Tahagod H Mohamed1,2,3, Brett Klamer4,5,6, John D Mahan4,7,8
1Division of Nephrology and Hypertension, Nationwide Children's Hospital, 700 Children's Dr, Columbus, OH, USA. Tahagod.Mohamed@Nationwidechildrens.org.
Insights
Diuretics are commonly used for acute kidney injury (AKI) in preterm infants, but their use varies widely. While beneficial for some, older infants receiving diuretics showed worse survival, suggesting underlying illness severity, not the treatment itself.
Area of Science:
- Neonatal Medicine
- Pediatric Nephrology
- Clinical Research
Background:
- Acute kidney injury (AKI) in preterm infants is a significant concern, linked to increased hospitalization and mortality.
- Diuretic therapy is a common intervention to manage urine output in these vulnerable infants.
- Limited data exists on diuretic prescription patterns and their impact on outcomes like length of stay, mechanical ventilation, and mortality in preterm infants with AKI.
Purpose of the Study:
- To evaluate diuretic treatment patterns in preterm infants diagnosed with AKI.
- To investigate the association between diuretic use and clinical outcomes, including length of stay (LOS), mechanical ventilation (MV), and mortality.
- To analyze variations in diuretic prescription practices across different Neonatal Intensive Care Units (NICUs).
Main Methods:
- A multicenter retrospective study utilizing the Pediatric Hospital Information System database.
- Inclusion of 2121 preterm infants (<37 weeks gestational age) with an AKI diagnosis from 46 US NICUs.
- Analysis of diuretic treatment, practice patterns, LOS, MV, and mortality.
Main Results:
- Seventy-six percent of preterm infants with AKI received diuretics, with a median treatment duration of 18 days.
- Significant variation in diuretic prescription rates (42-96%) observed across hospitals.
- Diuretics were more frequently administered to infants with younger gestational age (GA) and lower birth weight. Infants with older GA receiving diuretics showed worse survival, potentially due to more severe underlying illness.
Conclusions:
- Diuretic use is frequent in preterm infants with AKI, with notable variations in practice.
- Infants with younger GA and lower birth weight were more likely to receive diuretics.
- Worse survival in older infants with AKI receiving diuretics may reflect illness severity rather than a causal effect of the treatment, necessitating further prospective research.
Background:
Acute kidney injury (AKI) in preterm infants is associated with prolonged hospitalization and high mortality. Diuretic therapy has been used to enhance urine output in preterm infants with AKI. Treatment with diuretics, prescription patterns, and relationship with length of stay (LOS), mechanical ventilation (MV), and mortality in preterm infants who also had AKI have not been fully evaluated.
Methods:
This multicenter retrospective study used the Pediatric Hospital Information System database. We included 2121 preterm infants with AKI diagnosis from 46 hospital Neonatal Intensive Care Units (NICUs) born <37 weeks gestational age (GA). Treatment with diuretics, practice patterns across 46 NICUs in the USA, and associated outcomes including LOS, MV, and mortality were evaluated.
Results:
Seventy-six percent of infants received at least one dose of diuretics (median treatment 18 days). Diuretic prescription varied significantly across hospitals and ranged from 42 to 96%. Diuretics were used more frequently in infants with younger GA and smaller birth weight. Infants with older GA who received diuretics at or before 28 days postnatally had worse survival even after adjusting for known confounders.
Conclusions:
Preterm infants with AKI diagnosis were frequently treated with diuretics. Moreover, infants with younger GA and smaller birth weight were more likely to receive diuretics. Worse survival in infants with older GA who received diuretics could be the result of more underlying severe illness in these infants and not the cause of more severe illness. Prospective studies are needed to best determine patient safety and outcomes with diuretic treatment in preterm infants with AKI. A higher resolution version of the Graphical abstract is available as Supplementary information.
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