Intervention Review

Diuretics acting on the distal renal tubule for preterm infants with (or developing) chronic lung disease

  1. Audra Stewart2,
  2. Luc P Brion1,*,
  3. Iris Ambrosio-Perez3

Editorial Group: Cochrane Neonatal Group

Published Online: 7 SEP 2011

Assessed as up-to-date: 27 DEC 2010

DOI: 10.1002/14651858.CD001817.pub2


How to Cite

Stewart A, Brion LP, Ambrosio-Perez I. Diuretics acting on the distal renal tubule for preterm infants with (or developing) chronic lung disease. Cochrane Database of Systematic Reviews 2011, Issue 9. Art. No.: CD001817. DOI: 10.1002/14651858.CD001817.pub2.

Author Information

  1. 1

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

  2. 2

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

  3. 3

    Children's Hospital of Los Angeles, Division of Pediatric Pulmonology, Los Angeles, CA, USA

*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: 7 SEP 2011

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Abstract

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

Background

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

Objectives

To assess the risks and benefits of diuretics acting on distal segments of the renal tubule (distal diuretics) in preterm infants with or developing chronic lung disease (CLD).

Search methods

The standard method of the Cochrane Neonatal Review Group were used. Initially, MEDLINE (1966 to November 2001), EMBASE (1974 to November 2001) and the Cochrane Controlled Trials Register (CENTRAL,The Cochrane Library, Issue 4, 2001) were searched. In addition, several abstract books of national and international American and European Societies were hand searched. Updated searches in April 2003, April 2007, and December 2010 did not yield any additional trials.

Selection criteria

Included in this analysis are trials in which preterm infants with or developing CLD and at least five days of age were randomly allocated to receive a diuretic acting on the distal renal tubule. Eligible studies needed to assess at least one of the outcome variables defined a priori for this systematic review.

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. Any disagreement was resolved by discussion. Parallel and cross-over trials were combined. Whenever possible, baseline and final outcome data measured on a continuous scale was transformed into change scores using Follmann's formula.

Main results

Of the six studies fulfilling entry criteria, most 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 with CLD, a four week treatment with thiazide and spironolactone improved lung compliance and reduced the need for furosemide. A single study showed thiazide and spironolactone decreased the risk of death and tended to decrease the risk for remaining intubated after eight weeks in infants who did not have access to corticosteroids, bronchodilators or aminophylline.

Authors' conclusions

In preterm infants > 3 weeks of age with CLD, acute and chronic administration of distal diuretics improve pulmonary mechanics. However, positive effects should be interpreted with caution as the numbers of patients studied are small in surprisingly few randomized controlled trials.

 

Plain language summary

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

Diuretics acting on the distal renal tubule for preterm infants with (or developing) chronic lung disease

There is no strong evidence of benefit from routine use of distal diuretics in preterm infants with chronic lung disease. Lung disease in infants born early (preterm) is often complicated with excess of water. Medications that reduce body water (diuretics) might help the infant recover from lung disease. The review of trials analysed the effects of diuretics working on the end of the small kidney tubes (distal diuretics). It found that diuretic treatment for four weeks improved lung function. Only one study showed long term benefit (decreased rates of death and artificial ventilation). However, the infants in these trials did not receive all the medications that are currently available.