Intervention Review

Aerosolized diuretics for preterm infants with (or developing) chronic lung disease

  1. Luc P Brion1,*,
  2. R A Primhak2,
  3. W Yong3

Editorial Group: Cochrane Neonatal Group

Published Online: 19 JUL 2006

Assessed as up-to-date: 9 SEP 2009

DOI: 10.1002/14651858.CD001694.pub2


How to Cite

Brion LP, Primhak RA, Yong W. Aerosolized diuretics for preterm infants with (or developing) chronic lung disease. Cochrane Database of Systematic Reviews 2006, Issue 3. Art. No.: CD001694. DOI: 10.1002/14651858.CD001694.pub2.

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

  3. 3

    Universiti Kebangsaan Malaysia, Department of Pediatrics, 56000 Cheras, Kuala Lumpur, Malaysia

*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: New search for studies and content updated (no change to conclusions)
  2. Published Online: 19 JUL 2006

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. Laienverständliche Zusammenfassung

Background

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

Objectives

To determine the risks and benefits of aerosolized diuretic administration in preterm infants with or developing chronic lung disease (CLD). Primary objectives are to assess effects on short-term outcome (changes in need for oxygen or ventilatory support) and effects on long-term outcome. Secondary objectives are to assess changes in pulmonary mechanics and potential complications of therapy.

Search methods

We used the standard search method of the Cochrane Neonatal Review Group. We searched the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 1, 2006), MEDLINE (1966 to 1998) and EMBASE (1974 to 1998). We hand searched several abstract books of national and international American and European Societies. The searches of MEDLINE (search via PubMed), CINAHL, EMBASE and The Cochrane Library were updated in July 2009.

Selection criteria

We included trials in which preterm infants with or developing CLD and at least five days of age were randomly allocated to receive an aerosolized loop diuretic.

Data collection and analysis

We used the standard method for the Cochrane Collaboration. We combined parallel and cross-over trials and, whenever possible, transformed baseline and final outcome data measured on a continuous scale into change scores using Follmann's formula.

Main results

Eight studies met selection criteria. Most studies focused on pathophysiological parameters and did not assess effects on important clinical outcomes or potential complications of diuretic therapy. No study assessed the amount of diuretic effectively delivered to the patient. Furosemide was the only diuretic used in the eight studies included in this review.

Among preterm infants < 3 weeks of age developing CLD, not enough information is available to assess the effect of aerosolized furosemide on outcome or lung function.

Among infants > 3 weeks with CLD, a single aerosolized dose of 1 mg/kg of furosemide may transiently improve pulmonary mechanics. Not enough information is available to assess the effect of chronic administration of aerosolized furosemide on oxygenation and pulmonary mechanics.

Authors' conclusions

In preterm infants > 3 weeks with CLD administration of a single dose of aerosolized furosemide improves pulmonary mechanics. In view of the lack of data from randomized trials concerning effects on important clinical outcomes, routine or sustained use of aerosolized loop diuretics in infants with (or developing) CLD cannot be recommended based on current evidence.

Randomized controlled trials are needed to evaluate clinically important effects of aerosolized diuretics.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. Laienverständliche Zusammenfassung

Aerosolized diuretics for preterm infants with (or developing) chronic lung disease

There is no evidence of benefit from routine use of inhaled diuretics in preterm babies at risk of chronic lung disease. Lung disease in babies born early (preterm) is often complicated with excess accumulation of water in the lungs. Medications that reduce body water (diuretics) might help the baby recover from lung disease. In theory, giving the diuretic as an inhaled mist (aerosol) could drain water from the lung more than from the rest of the body, which could reduce adverse effects. The review found several small trials of a single type of diuretic (furosemide). A single dose improved lung function, but only temporarily. No information was available about long term outcome.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. Laienverständliche Zusammenfassung

背景

霧化利尿劑治療慢性肺部疾病(或發展中)的早產兒

早產兒肺部疾病(肺疾)常並發肺水腫

目標

本評價旨在評估霧化利尿劑治療患慢性肺部疾病(慢性肺疾,CLD)(或發展中)早產兒的風險和好處。主要目的是評估對短期結局(氧氣或通氣支持需要的變化)和對遠期結局的影響。第二個目的是評估肺力學變化和治療的潛在併發症。

搜尋策略

我們使用Cochrane新生兒評價組的標準檢索方法。我們使用的關鍵詞如下: { 或} 和,限於和限於或。我們檢索了MEDLINE (1966年 1998年)、EMBASE (1974年 1998年) 和Cochrane對照試驗中心註冊資料庫(CENTRAL, Cochrane圖書館,2006年第1期)。此外,我們檢索了全國的和美國與歐洲的國際學會的幾種摘要彙編。 2006年3月對MEDLINE和CENTRAL的檢索進行了最新更新。

選擇標準

為進行該分析,我們納入將患慢性或發展中慢性肺疾並至少出生5天的早產兒所有隨機分配接受霧化利尿劑治療的試驗。合格研究必須至少有本系統評價預先確定的評估結局變量之一。主要結局變量包括呼吸器支持需要、慢性肺疾、死亡率和其它重要臨床結局。次要結局變量包括肺力學和治療的潛在併發症。

資料收集與分析

我們使用Cochrane協作組織手冊中介紹的Cochrane協作組織的標準方法。兩位評價員各自提取、評估和編碼每項研究的全部數據,及使用為本評價專門設計的表格。通過討論解決不一致處。我們對平行和交叉試驗進行合併,只要可能,根據連續量表測定的基線和最終結局數據使用Follmann公式轉換為變化評分。

主要結論

我們查找到符合選擇標準的研究八項。多數研究以病理生理學參數評估為重點,未評估本評價所確定的重要臨床結局或利尿劑治療的潛在併發症。沒有一項研究評估利尿劑有效地進入患者體內的量。本評價納入的八項研究僅使用furosemide一種利尿劑

作者結論

一次性劑量霧化速尿應用於出生不足3週CLD早產兒可改善呼吸力學。鑑於隨機試驗缺乏有關重要臨床結局影響的數據,根據現有證據不推薦對CLD(或發展中CLD)嬰兒常規或持續應用霧化利尿劑。還需要臨床對照實驗來評估霧化利尿劑的臨床重大效果.

翻譯人

本摘要由臺中榮民總醫院薛榮華翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

霧化利尿劑治療早產兒的(或發展中的)慢性肺疾病:沒有任何證據表明常規使用吸入型利尿劑於有慢性肺部疾病風險的早產兒會有好處。在提早出生嬰兒(早產)的肺部疾病往往合併肺部累積過多的水。可減少體內水分(利尿劑)的藥物可能有助於嬰兒從肺部疾病中恢復。從理論上講,給予吸入噴霧(氣溶膠)利尿劑可從肺部中引流出更多的水勝過從其餘的身體部份,且可減少不良影響。這次回顧發現幾個小試驗使用單一類型利尿劑(furosemide)。單一劑量可改善肺功能,但只是暫時的。沒有提供長期結果的有關資料。

 

Laienverständliche Zusammenfassung

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. Laienverständliche Zusammenfassung

Inhalierbare Diuretika für Frühgeborene, die eine chronische Lungenerkrankung entwickeln oder bereits haben

Es gibt keine Evidenz zum Nutzen von inhalierten Diuretika bei Frühgeborenen, die Gefahr laufen, eine chronische Lungenerkrankung zu entwickeln. Lungenerkrankungen bei zu früh geborenen Säuglingen werden häufig durch zu viel Wasser in der Lunge verschlimmert. Entwässernde Medikamente (Diuretika) können möglicherweise dazu beitragen, dass Säuglinge sich von einer Lungenerkrankung erholen. Theoretisch würde ein Diuretikum, das als Aerosol inhaliert wird, bewirken, dass mehr Wasser aus der Lunge ausgeschwemmt wird als aus dem übrigen Körper. Dies könnte helfen, unerwünschte Nebenwirkungen zu vermindern. Für diesen Review wurden mehrere kleinere Studien gefunden, die eine Klasse entwässernder Medikamente (Furosemid) untersucht haben. Eine einmalige Dosis verbesserte die Lungenfunktion, allerdings nur vorübergehend. Es gab keine Information über langfristige Endpunkte.

Anmerkungen zur Übersetzung

Koordination durch Cochrane Schweiz.