Purpose: Extremely low birth weight (ELBW, < 1000g) infants are at risk for prolonged assisted ventilation, elevating risk for lung injury, bronchopulmonary dysplasia (BPD) and death. Furosemide and bumetanide are diuretics used to reduce respiratory support. Use of diuretics in ELBW infants is off-label; safety and efficacy is unknown. The objective of this study is to compare the incidence of clinical outcomes in ELBW infants at 2 neonatal intensive care units (NICUs) with different furosemide and bumetanide prescribing practices. Methods: Data were collected from all ELBW infants born < 32 weeks without major anomalies and admitted < 7 postnatal days to 2 NICUs from 2007-2012. The incidence of death, BPD, bilateral hearing aids, nephrocalcinosis/nephrolithiasis, and neurodevelopmental impairment (NDI) before 30 months of age were compared between the 2 NICUs. BPD was defined as requiring >21% oxygen, positive pressure ventilation, or continuous positive pressure at 36 weeks postmenstrual age. NDI was defined as scoring < 70 on the Mental or Psychomotor Development Indices, or < 85 on the Cognitive Area Composite Score on the Bayley Scales of Infant Development; having severe impairment that precluded developmental testing; or having cerebral palsy. Fisher’s exact test, chi-square test, and the Mann-Whitney U test were used to compare data where appropriate. Results: Among 765 ELBW infants, the median gestational age and birth weight were 25 weeks (range: 23-32) and 740 g (280-997), and were similar between sites (Table). Median duration of treatment and combined doses at site 1 were 7-fold and 19-fold greater than site 2, respectively. Site 1 had a lower incidence of BPD and death/BPD, but had a higher incidence of nephrocalcinosis/nephrolithiasis and bilateral hearing aids. There was no difference in the incidence of NDI. Conclusions: Diuretics use and dosing between the 2 sites differed significantly. The site with higher use had a lower incidence of BPD and death/BPD, but higher incidence of nephrocalcinosis/nephrolithiasis and bilateral hearing aids compared to the site with lower use. However, the need for bilateral hearing aids was rare (1%), and screening for nephrocalcinosis/nephrolithiasis was not performed systematically at either site. The incidence of death and NDI were similar between the 2 sites. Given the frequency of use and lack of prospective data, the safety and efficacy of diuretics in ELBW infants should be evaluated in a prospective, randomized trial.

Table.

Demographics, diuretics dosing, and clinical outcomes by site

Table.

Demographics, diuretics dosing, and clinical outcomes by site

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