Randomized comparison of continuous versus intermittent bolus furosemide in neonatal heart failure

In term neonates with heart failure, optimizing diuresis is critical, yet evidence for best practice is sparse. This study aims to compare the effectiveness of continuous infusion versus intermittent bolus furosemide in improving pulmonary status, hemodynamics, renal function, and intensive care unit (ICU) length of stay in neonates with heart failure.

A randomized trial was conducted involving 52 infants (26 per group) to compare continuous infusion versus intermittent bolus furosemide. The primary outcomes measured were pulmonary status (oxygenation and ventilator days), hemodynamics, renal function, and ICU length of stay.

Infants receiving continuous infusion of furosemide showed more rapid improvement in ventilation and acid-base status. They had higher blood pH and lower PaCO₂ (mean pH 7.34 vs. 7.26, PaCO₂ 46 vs. 53 mmHg; both P < 0.01), shorter ventilator time (4.0 vs. 5.5 days, P = 0.009), and shorter neonatal intensive care unit stay (11.5 vs. 15.2 days, P < 0.001) compared to the bolus group. Serum creatinine levels decreased significantly in both groups, indicating improved renal function, with no significant difference between groups (P > 0.05). Electrolyte levels and systolic blood pressure were similar across both groups.

Continuous infusion of furosemide provides steadier diuresis with superior pulmonary recovery, whereas intermittent bolus dosing yields comparable renal outcomes and hemodynamic stability. Clinically, continuous infusion may be preferred for neonates with pulmonary edema and ventilation needs, while bolus dosing can be used when electrolyte stability is paramount.