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Abstract

We would like to respond to Dr Koumbourlis' letter. We took the approach in this analysis to focus on substantive, clinically meaningful change in respiratory status as our outcome measure. Physiologic changes of lung compliance could be measured in infants born premature exposed to diuretics in modern neonatal intensive care units; however, we feel that weaning off of positive pressure ventilation is important to families and staff more than short-term potential changes in peak inspiratory pressure and fraction of inspired oxygen. Dr Koumbourlis states that “A more plausible explanation would be that these patients required more support because they were more premature and had been considerably sicker since birth.” The model we used already accounted for the fact that they were more premature and sicker when treatment started. What we found was that, despite accounting for prematurity and other factors, the babies receiving diuretics still required more respiratory support. We also modeled an 8-level outcome that used cutoffs of > or ≤0.21 fraction of inspired oxygen, which also showed a negative effect of diuretics. We agree with Dr Koumbourlis that our findings do not alone indicate whether diuretics should be used in the clinical care of newborns who are premature. Our findings do raise the question whether further study to support ongoing use of diuretics is needed. Babies have benefited from significant changes in neonatal intensive care unit therapies and supportive care practices in the past decades, and it's time to re-examine diuretics. Diuretics in newborns born extremely premature: the jury is still outThe Journal of PediatricsVol. 201PreviewIn their study, Blaisdell et al conclude that diuretics do not “substantially improve the respiratory status of the infant born extremely premature.”1 I disagree with this interpretation. The main outcome measure of the study was “change in the respiratory status,” defined on the basis of 5 very broad categories (“deceased,” “endotracheal tube,” “continuous positive airway pressure or nasal cannula >2 liters per minute,” “nasal cannula <2 LPM,” and “no support”; their Table II) that are not sensitive enough to detect the incremental improvement that may result from the use of diuretics. Full-Text PDF