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[Diuretics in the neonatal period]

J P Guignard1, L Dubourg, J B Gouyon

  • 1Service de pédiatrie, CHUV, Lausanne, Suisse.

Revue Medicale De La Suisse Romande
|August 1, 1995
PubMed
Summary

Diuretics like furosemide are essential for neonatal fluid and electrolyte management, but require careful monitoring due to prolonged effects and potential side effects in infants. Long-term use may lead to complications, necessitating cautious administration.

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Area of Science:

  • Neonatal pharmacology
  • Pediatric nephrology
  • Clinical therapeutics

Context:

  • Fluid and electrolyte balance is critical in neonatal pathological conditions.
  • Diuretic agents are frequently employed for management in neonates.
  • Understanding drug pharmacokinetics and effects in newborns is essential.

Purpose:

  • To review the use, efficacy, and safety of diuretic agents in neonatal care.
  • To highlight the specific properties of furosemide in newborn infants.
  • To discuss potential benefits and risks associated with diuretic therapy in neonates.

Summary:

  • High-efficacy loop diuretics (furosemide, bumetanide, ethacrynic acid) are commonly used. Furosemide exhibits prolonged elimination half-life and renal effects in neonates compared to adults.
  • Furosemide administration can lead to significant water, sodium, and potassium losses. Combinations like furosemide-dopamine may aid renal insufficiency in respiratory distress syndrome (RDS).
  • Long-term furosemide use is linked to metabolic alkalosis, hypokalemia, renal calcifications, cholelithiasis, and potential worsening of bronchopulmonary dysplasia (BPD) outcomes. Otoxicity risk is unclear. Thiazides and potassium-sparing diuretics have different efficacy and indications.

Impact:

  • Provides a comprehensive overview of diuretic use in neonates, informing clinical practice.
  • Highlights the need for individualized dosing and close monitoring of neonates receiving diuretics.
  • Emphasizes the importance of weighing the benefits against potential adverse effects in neonatal populations.

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