Study finds significant variation over diuretics use in BPD patients

Even though there is little data to support the extended use of diuretic medications to help reduce fluid build-up in the lungs of premature infants, researchers at Nationwide Children's Hospital have found significant variation in how babies receive these medications at hospitals across the nation.

"There are minimal data on the efficacy or side effects of the extended use of diuretics in preterm infants needing breathing support, yet long-term use is routine among the nation's neonatal intensive care units," said Jonathan Slaughter, MD, MPH, principal investigator in the Center for Perinatal Research and a neonatologist at Nationwide Children's Hospital.

Slaughter's study, published in the March issue of Pediatrics, evaluated data gathered during a 54-month period from 35 US children's hospitals involving 1429 infants with Bronchopulmonary dysplasia, or BPD.

BPD is a multifaceted inflammatory disease that affects low birth weight, preterm infants who spend long periods of time on oxygen and mechanical ventilation. The use of diuretic medications for preterm infants with BPD has been a common regimen for more than 30 years, and helps reduce fluid that could further clog inflamed airways.

Researchers found that among hospitals with at least 15 BPD patients, the percentage of infants receiving a diuretic course of longer than five days ranged from 4 percent to 86 percent.

Overall, 86 percent of the infants in the study received a diuretic, with 84 percent of those infants receiving at least one course of the drug for five days or less, and 40 percent receiving courses of medication for longer than five consecutive days.

"We found that the length of time infants required mechanical ventilation was the greatest predictor of diuretic medication use," explained. "On average, among infants that develop BPD, courses of diuretic use of five days or less predominate in the first month of life, with more than five days of diuretic use more common thereafter."

Slaughter's findings are consistent with a separate study of 400 neonatologists examining their clinical decisions to use diuretics. That study showed that 66 percent of the respondents expected decreased ventilator days and 59 percent expected decreased length of stay for the patient with long-term use of diuretics.

"Our baseline findings can serve as the foundation for a prospective comparative effectiveness study to determine whether long-term use of diuretics in BPD patients is truly beneficial," said Slaughter, who is also an assistant professor of pediatrics at The Ohio State University College of Medicine. "Additionally, the variations also indicate a real need for guidelines around the use of diuretics in this patient population."

Along with asthma and cystic fibrosis, BPD is one of the most common chronic lung diseases in children. According to the National Heart, Lung, and Blood Institute (NHLBI), between 5,000 and 10,000 cases of BPD occur every year in the United States. While most cases of BPD resolve, some children experience lifelong lung issues because of BPD.

"We have a critical need for a better understanding of the benefits and side effects in diuretic-exposed patients. If long-term diuretic use is shown to be advantageous for BPD patients, more research will be needed to determine which type of diuretics provide the most benefit and the lowest long-term risks," added Slaughter.