Furosemide Safety in Preterm Infants at Risk for Bronchopulmonary Dysplasia: A Randomized Clinical Trial

Area of Science:

• Neonatal Medicine
• Pediatric Pharmacology
• Respiratory Medicine

Background:

• Bronchopulmonary dysplasia (BPD) is a common complication in preterm infants.
• Furosemide is often used in neonates, but its safety profile in this population requires further investigation.

Purpose of the Study:

• To evaluate the safety and efficacy of furosemide in preterm infants at risk for BPD.
• To assess the incidence of adverse events (AEs), BPD, death, hearing loss, and nephrocalcinosis.

Main Methods:

• A multicenter, randomized, dose-escalating, placebo-controlled trial.
• Infants born <29 weeks gestational age were randomized to receive escalating doses of furosemide or placebo for 28 days.
• Outcomes included total AEs, BPD, death, hearing loss, electrolyte abnormalities, and nephrocalcinosis.

Main Results:

• No significant difference in overall AEs, BPD, death, hearing loss, or nephrocalcinosis between furosemide and placebo groups.
• Furosemide use was associated with a significant increase in serum electrolyte abnormalities (P = .048 and P = .023 in cohorts).

Conclusions:

• Furosemide is safe regarding overall AEs, hearing loss, and nephrocalcinosis in preterm infants at risk for BPD.
• Furosemide increases the risk of electrolyte abnormalities but does not impact rates of moderate-to-severe BPD or death.