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J Pediatr. 2018 Dec 20. pii: S0022-3476(18)31690-1. doi: 10.1016/j.jpeds.2018.11.043. [Epub ahead of print]

Furosemide Exposure and Prevention of Bronchopulmonary Dysplasia in Premature Infants.

Author information

1
Department of Pediatrics, Duke University School of Medicine, Durham, NC; Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC. Electronic address: rachel.greenberg@duke.edu.
2
Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC.
3
Pediatrix-Obstetrix Center for Research and Education, Sunrise, FL.
4
Clemson University, Clemson, SC.
5
Department of Pediatrics, The University of North Carolina-Chapel Hill, Chapel Hill, NC.
6
Department of Pediatrics, Duke University School of Medicine, Durham, NC; Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC.

Abstract

OBJECTIVE:

To evaluate the association between furosemide exposure and risk of bronchopulmonary dysplasia (BPD).

STUDY DESIGN:

This retrospective cohort study included infants (2004-2015) born at 23-29 weeks gestational age and 501-1249 g birth weight. We compared the demographic and clinical characteristics of infants exposed and not exposed to furosemide between postnatal day 7 and 36 weeks postmenstrual age. We examined the association between furosemide exposure and 2 outcomes: BPD and BPD or death. We performed multivariable probit regression models that included demographic and clinical variables in addition to 2 instrumental variables: furosemide exposure by discharge year, and furosemide exposure by site.

RESULTS:

Of 37 693 included infants, 19 235 (51%) were exposed to furosemide; these infants were more premature and had higher respiratory support. Of 33 760 infants who survived to BPD evaluation, 15 954 (47%) had BPD. An increase in the proportion of furosemide exposure days by 10 percentage points was associated with a decrease in both the incidence of BPD (4.6 percentage points; P = .001), and BPD or death (3.7 percentage points; P = .01).

CONCLUSIONS:

More days of furosemide exposure between postnatal day 7 and 36 weeks was associated with decreased risk of BPD and a combined outcome of BPD or death.

KEYWORDS:

BPD; chronic lung disease; diuretic; neonate; preterm

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