Furosemide Exposure and Prevention of Bronchopulmonary Dysplasia in Premature Infants

• Published in: The Journal of pediatrics 2019-05, Vol.208, p.134-140.e2
• Main Authors: Greenberg, Rachel G., Gayam, Sreepriya, Savage, Destiny, Tong, Andrew, Gorham, Daniel, Sholomon, Ari, Clark, Reese H., Benjamin, Daniel K., Laughon, Matthew, Smith, P. Brian
• Format: Article
• Language: English
• Subjects: Birth Weight; BPD; Bronchopulmonary Dysplasia - prevention & control; chronic lung disease; diuretic; Drug Administration Schedule; Female; Furosemide - administration & dosage; Gestational Age; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases - prevention & control; Infant, Very Low Birth Weight; Male; Multivariate Analysis; neonate; preterm; Retrospective Studies; Sodium Potassium Chloride Symporter Inhibitors - administration & dosage; Treatment Outcome
• ISSN: 0022-3476; 1097-6833; 1097-6833
• DOI: 10.1016/j.jpeds.2018.11.043

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