Association between route of furosemide administration and diuretic response in very preterm infants with bronchopulmonary dysplasia

Area of Science:

• Neonatal Medicine
• Pediatric Pharmacology
• Respiratory Medicine

Background:

• Furosemide is frequently used for hospitalized infants with bronchopulmonary dysplasia (BPD).
• Common administration routes include intravenous (IV), gastric, and duodenal.
• The standard 1:2 IV-to-enteral conversion ratio's efficacy is not well-established due to uncertain enteral bioavailability.

Purpose of the Study:

• To compare the diuretic response to furosemide across different administration routes in infants diagnosed with BPD.
• To evaluate the effectiveness of the common 1:2 IV-to-enteral conversion in this patient population.

Main Methods:

• A single-center observational cohort study was conducted on very preterm infants with grade 2-3 BPD.
• Furosemide administration routes (IV, gastric, duodenal) were assessed as the exposure.
• Diuretic response, defined as the change in net fluid balance, was the primary outcome, analyzed using multivariable regression.

Main Results:

• The study included 153 infants with a median postmenstrual age of 43.3 weeks.
• Furosemide administration resulted in a mean fluid balance reduction of -25.6 ml/kg/d.
• Adjusted mean fluid balance changes were comparable across IV (-25.3 ml/kg/d), gastric (-25.8 ml/kg/d), and duodenal (-25.8 ml/kg/d) routes.

Conclusions:

• The findings suggest that a 1:2 IV-to-enteral furosemide conversion yields comparable diuretic effects in infants with established BPD.
• This supports the current clinical practice of using this conversion ratio for managing fluid balance in infants with BPD.