Postnatal diuretics, weight gain and home oxygen requirement in extremely preterm infants.

Emma E Williams,Nicholas K Donaldson,Shannon Gunawardana,Anne Greenough,Theodore Dassios

doi:10.1515/jpm-2021-0256

Abstract

Diuretics are often given to infants with evolving/established bronchopulmonary dysplasia (BPD) with the hope of improving their pulmonary outcomes. We aimed to determine if diuretic use in preterm infants was associated with improved pulmonary outcomes, but poorer weight gain. An observational study over a 5year period was undertaken of all infants born at less than 29weeks of gestation and alive at discharge in all neonatal units in England who received consecutive diuretic use for at least 7days. Postnatal weight gain and home supplementary oxygen requirement were the outcomes. A literature review of randomised controlled trials (RCTs) and crossover studies was undertaken to determine if diuretic usage wasassociated with changes in lung mechanics and oxygenation, duration of supplementary oxygen and requirement for home supplementary oxygen. In the observational study, 9,457 infants survived to discharge, 44.6% received diuretics for at least 7days. Diuretic use was associated with an increased probability of supplementary home oxygen of 0.14 and an increase in weight gain of 2.5g/week. In the review, seven of the 10 studies reported improvements only in short term lung mechanics. There was conflicting evidence regarding whether diuretics resulted in short term improvements in oxygenation. Diuretic use was not associated with a reduction in requirement for supplemental oxygen on discharge. The literature review highlighted a lack of RCTs assessing meaningful long-term clinical outcomes. Randomised trials are needed to determine the long-term risk benefit ratio of chronic diuretic use.

Highlights

Bronchopulmonary dysplasia (BPD) is associated with long-term adverse pulmonary outcomes such as supplementary oxygen requirement at home, rehospitalisation and reduced pulmonary function in childhood [1, 2]
We have demonstrated that diuretic use did not reduce the need for supplemental oxygen on discharge home from the neonatal intensive care unit and was associated with greater weight gain from birth to discharge in those extremely preterm infants
Diuretics have been shown to be commonly prescribed to infants who are discharged on supplemental oxygen [19], yet with a lack of consensus on subsequent weaning regimes [20]

Summary

Introduction

Bronchopulmonary dysplasia (BPD) is associated with long-term adverse pulmonary outcomes such as supplementary oxygen requirement at home, rehospitalisation and reduced pulmonary function in childhood [1, 2]. To reduce such morbidity, preterm infants are often given medications, such as diuretics, in the hope of improving their respiratory status [3]. Retrospective analyses have demonstrated that, in infants with developing or established chronic lung disease, diuretic administration was associated with lower ventilatory pressures and less supplemental oxygen, but at the expense of reduced postnatal weight gain and electrolyte imbalance [5]. We have analysed data from a whole population and undertaken a review of the literature to determine if diuretic administration influenced clinically relevant pulmonary and growth outcomes

Materials and methods

Results

Discussion