Variability in Duration of Outpatient Diuretic Therapy in Bronchopulmonary Dysplasia: A Clinical Experience

Abstract

We describe usual duration of outpatient diuretic therapy and duration of tapering of outpatient diuretics in infants with established bronchopulmonary dysplasia (BPD), and we identify factors associated with duration of diuretic taper. Infants with BPD discharged from the neonatal intensive care unit on diuretic therapy were identified and data were abstracted from clinical databases and medical records. BPD was defined as oxygen dependence at 28 days of life. Infants with chromosomal abnormalities or congenital heart disease and those requiring tracheostomy placement were excluded. Descriptive, univariate, and multivariate analyses were performed. Of 59 patients discharged on diuretic therapy, 10 were also discharged on oxygen. Median (25th, 75th percentiles) duration of outpatient diuretic therapy was 94 (69, 115) days and 30 (14, 84) days for duration of diuretic taper. Duration of therapy and duration of taper were significantly longer in infants discharged on oxygen. In Cox proportional hazards modeling, longer diuretic taper was associated with a higher dose of chlorothiazide at discharge, shorter interval to first outpatient visit, need for rehospitalization, and African-American race. Birth weight, gestational age, and various discharge therapies were not significantly associated with duration of taper after adjusting for these factors. In 58% of all patients, diuretics were tapered or discontinued at the first outpatient visit. This study demonstrated great variability in the duration of diuretic therapy and diuretic taper. Discharge on oxygen was associated with longer duration of diuretic therapy and taper. Active taper is successful in the majority of patients and should be considered in patients with stable BPD.