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Diuretic treatment for respiratory conditions unsupported for preterm neonates
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Extremely preterm infants who are treated with diuretics for respiratory conditions are more likely to require more invasive respiratory support every day after the treatment began, according to findings published in The Journal of Pediatrics.
"Prescribing patterns for diuretics vary among hospitals,” Anne Zajicek, MD, PharmD, from deputy director of the NIH Office of Clinical Research, said in a press release. “We set out to explore whether this therapy helps very premature infants, but we found that it may be ineffective, which was contrary to what we expected.”
To analyze whether the use of diuretic treatment in extremely premature infants born between 23 to 28 weeks improved their daily respiratory status when compared with other infants not exposed to the treatment, the researchers conducted a multicenter observational cohort study that assessed infants from 13 tertiary NICUs located in the United States. All infants were recruited within their first week of life, and Zajicek and colleagues examined medication administration and the need for respiratory support of infants 34 weeks’ postmenstrual age or younger.
Of the 835 neonates included in the study, 483 were administered a diuretic at least once, and the unexposed cohort included 352 infants. Three of the participants did not have any medication information and were not included in the analysis.
Infants who were administered a diuretic were more likely to have a lower average gestational age (exposed: 26.1 weeks; unexposed: 27.2 weeks; P < .0001). These infants also had lower birthweights (exposed: 825 g; unexposed: 1,002 g; P < .0001). The researchers observed that no significant difference was noticed between the groups regarding sex, race or ethnicity.
Furthermore, infants exposed to diuretics had substantially lower Apgar scores at 1 and 5 minutes (P <.0001), were not as likely to be resuscitated using continuous positive airway pressure (44% vs. 68%; P < .0001) and are more likely to have had previous resuscitation that used positive pressure ventilation (58% vs. 43%; P = .0003). These infants were also more likely to be previously intubated (90% vs. 75%; P < .0001), received chest compression (19% vs. 11%) and administered cardiac drugs (9% vs. 3%) and surfactant (74% vs. 60%; P = .0001). Nearly all infants (90%) required supplemental oxygen treatment.
By the time these infants reached 14 days of age, those who were exposed to diuretics required significantly more invasive respiratory support than those who were not treated with the drugs (unadjusted P < .0001). Ventilatory support with an endotracheal tube was needed for 56% of exposed infants compared with 11% of those who are not treated. When initially administered diuretics, 28% were provided continuous positive airway pressure or more than 2 liters per minute nasal cannula compared with 38% of infants who did not receive diuretics.
Additionally, 7% of infants administered diuretics were supported by nasal cannula less than 2 liters per minute compared with 10% of unexposed infants. When the researchers assessed whether infants received no respiratory support, they observed that only 9% received no support, whereas those left unexposed to diuretics were less likely to require additional support (40%).
“The study reinforces growing concerns about the risk and possible benefits of diuretics, which are one of the most commonly prescribed classes of medications in the NICU,” Carol Blaisdell, MD, a senior program officer in the Environmental Influences and Child Health Outcome program within the NIH Office of the Director, said in the release. – by Katherine Bortz
Disclosures: The authors report no relevant financial disclosures.
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