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Diuretic exposure in premature infants from 1997 to 2011.
- Source :
-
American journal of perinatology [Am J Perinatol] 2015 Jan; Vol. 32 (1), pp. 49-56. Date of Electronic Publication: 2014 May 06. - Publication Year :
- 2015
-
Abstract
- Objective: Diuretics are often prescribed off-label to premature infants, particularly to prevent or treat bronchopulmonary dysplasia. We examined their use and safety in this group.<br />Study Design: Retrospective cohort study of infants < 32 weeks gestation and < 1,500 g birth weight exposed to diuretics in 333 neonatal intensive care units from 1997 to 2011. We examined use of acetazolamide, amiloride, bumetanide, chlorothiazide, diazoxide, ethacrynic acid, furosemide, hydrochlorothiazide, mannitol, metolazone, or spironolactone combination. Respiratory support and fraction of inspired oxygen on the first day of each course of diuretic use were identified.<br />Results: About 37% (39,357/107,542) infants were exposed to at least one diuretic; furosemide was the most commonly used (93% with ≥ 1 recorded dose), followed by spironolactone, chlorothiazide, hydrochlorothiazide, bumetanide, and acetazolamide. About 74% patients were exposed to one diuretic at a time, 19% to two diuretics simultaneously, and 6% to three diuretics simultaneously. The most common combination was furosemide/spironolactone, followed by furosemide/chlorothiazide and chlorothiazide/spironolactone. Many infants were not receiving mechanical ventilation on the first day of each new course of furosemide (47%), spironolactone (69%), chlorothiazide (61%), and hydrochlorothiazide (68%). Any adverse event occurred on 42 per 1,000 infant-days for any diuretic and 35 per 1,000 infant-days for furosemide. Any serious adverse event occurred in 3.8 for any diuretic and 3.2 per 1,000 infant-days for furosemide. The most common laboratory abnormality associated with diuretic exposure was thrombocytopenia.<br />Conclusion: Despite no Food and Drug Administration (FDA) indication and little safety data, over one-third of premature infants in our population were exposed to a diuretic, many with minimal respiratory support.<br /> (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)
- Subjects :
- Acetazolamide therapeutic use
Amiloride therapeutic use
Bronchopulmonary Dysplasia drug therapy
Chlorothiazide therapeutic use
Cohort Studies
Diazoxide therapeutic use
Drug Therapy, Combination
Ethacrynic Acid therapeutic use
Female
Furosemide therapeutic use
Humans
Hydrochlorothiazide therapeutic use
Infant, Extremely Premature
Infant, Newborn
Infant, Premature
Male
Mannitol therapeutic use
Metolazone therapeutic use
Off-Label Use
Retrospective Studies
Spironolactone therapeutic use
Bronchopulmonary Dysplasia prevention & control
Diuretics therapeutic use
Respiration, Artificial statistics & numerical data
Thrombocytopenia epidemiology
Subjects
Details
- Language :
- English
- ISSN :
- 1098-8785
- Volume :
- 32
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- American journal of perinatology
- Publication Type :
- Academic Journal
- Accession number :
- 24801161
- Full Text :
- https://doi.org/10.1055/s-0034-1373845