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Intervention Review

Intravenous or enteral loop diuretics for preterm infants with (or developing) chronic lung disease

  1. Luc P Brion1,*,
  2. R A Primhak2

Editorial Group: Cochrane Neonatal Group

Published Online: 23 OCT 2000

Assessed as up-to-date: 30 APR 2007

DOI: 10.1002/14651858.CD001453


How to Cite

Brion LP, Primhak RA. Intravenous or enteral loop diuretics for preterm infants with (or developing) chronic lung disease. Cochrane Database of Systematic Reviews 2000, Issue 4. Art. No.: CD001453. DOI: 10.1002/14651858.CD001453.

Author Information

  1. 1

    University of Texas Southwestern at Dallas, Division of Neonatal-Perinatal Medicine, Dallas, Texas, USA

  2. 2

    Sheffield Children's Hospital, Paediatrics, Sheffield, UK

*Luc P Brion, Division of Neonatal-Perinatal Medicine, University of Texas Southwestern at Dallas, 5323 Harry Hines Boulevard, Dallas, Texas, 75390-9063, USA. Luc.Brion@UTSouthwestern.edu.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 23 OCT 2000

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This is not the most recent version of the article. View current version (07 SEP 2011)

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary

Background

Lung disease in preterm infants is often complicated with lung edema.

Objectives

The aim of this review was to assess the risks and benefits of administration of a diuretic acting on the loop of Henle (loop diuretic) in preterm infants with or developing chronic lung disease (CLD). Primary objectives were to assess changes in need for oxygen or ventilatory support and effects on long-term outcome, and secondary objectives were to assess changes in pulmonary mechanics and potential complications of therapy.

Search strategy

The standard search method of the Cochrane Neonatal Review Group was used. The initial search included the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 1, 2003), MEDLINE (1966 to April 2003), EMBASE (1974 to 1998) and . In addition, several abstract books of national and international American and European Societies were hand searched. The MEDLINE and the Cochrane Central searches were updated in March 2007 and the EMBASE search in April 2007.

Selection criteria

Trials in which preterm infants with or developing chronic lung disease and at least five days of age were all randomly allocated to receive a loop diuretic either enterally or intravenously were included in this analysis. Eligible studies needed to assess at least one of the outcome variables defined a priori for this systematic review. Primary outcome variables included important clinical outcomes, and secondary outcome variables included toxicity and pulmonary mechanics (e.g., lung compliance and airway resistance).

Data collection and analysis

The standard method for the Cochrane Collaboration described in the Cochrane Collaboration Handbook were used. Two investigators extracted, assessed and coded separately all data for each study, using a form that was designed specifically for this review. Any disagreement was resolved by discussion. Parallel and cross-over trials were combined and, whenever possible, transformed baseline and final outcome data measured on a continuous scale into change scores using Follmann's formula.

Main results

The only loop diuretic used in the studies that met the selection criteria was furosemide. Most studies focused on pathophysiological parameters and did not assess effects on important clinical outcomes defined in this review, or the potential complications of diuretic therapy.
In preterm infants < 3 weeks of age developing CLD, furosemide administration has either inconsistent effects or no detectable effect.

In infants > 3 weeks of age with CLD, a single intravenous dose of 1 mg/kg of furosemide improves lung compliance and airway resistance for one hour. Chronic administration of furosemide improves both oxygenation and lung compliance.

Authors' conclusions

In preterm infants > 3 weeks of age with CLD, acute and chronic administration of furosemide improve lung compliance. Chronic administration of intravenous or enteral furosemide improves oxygenation. In view of the lack of data from randomized trials concerning effects on important clinical outcomes, routine or sustained use of systemic loop diuretics in infants with (or developing) CLD cannot be recommended based on current evidence.

Randomized trials are needed to assess the effects of furosemide administration on survival, duration of ventilatory support and oxygen administration, length of hospital stay, potential complications and long-term outcome.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary

Intravenous or enteral loop diuretics for preterm infants with (or developing) chronic lung disease

There is no strong evidence of benefit from routine use of loop diuretics in preterm babies at risk of, or with, chronic lung disease. Lung disease in babies born early (preterm) is often complicated with excess of water. Medications that reduce body water (diuretics) might help the baby recover from lung disease. The review analysed the effects of diuretics working on the deep part of the small kidney tubes (loop diuretics). The review of trials found that diuretics, given from a single dose to one week's treatment, inconsistently improved lung function and oxygen levels in the blood. There was not enough evidence to show any improvement in long-term outcome.