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Furosemide for transient tachypnea of the newborn

  • Review
  • Intervention

Authors


Abstract

Background

Transient tachypnea of the newborn results from delayed clearance of lung liquid and is a common cause of admission of full term infants to neonatal intensive care units. The condition is particularly common after elective Caesarean section. Conventional treatment involves appropriate oxygen administration and continuous positive airway pressure in some cases. Most infants receive antibiotic therapy. Hastening the clearance of lung liquid should shorten the duration of the symptoms and reduce complications.

Objectives

To determine whether furosemide reduces the duration of oxygen therapy and respiratory symptoms and shortens hospital stay in term infants with transient tachypnea of the newborn.

Search methods

We searched the Cochrane Controlled Trials Register, PubMed and EMBASE. The primary author and experts in the field were contacted.

Selection criteria

Randomised or quasi-randomised controlled trials. Infants of less than 7 days of age, born after 37 or more weeks of gestation with the clinical picture of transient tachypnea of the newborn. Intravenous, oral or nebulized furosemide compared to placebo or no diuretic in the first 7 days.

Data collection and analysis

Two reviewers assessed trial quality in each potentially eligible manuscript and two reviewers extracted data.

Main results

Searching revealed only one randomised trial which was methodologically sound. This recruited 50 infants with transient tachypnea. Infants were randomised to receive oral furosemide 2 mg/kg followed by 1 mg/kg 12 hours later, or placebo. Weight loss in the first 24 hours was greater in the furosemide treated group but there was no evidence of a difference between the groups in duration of tachypnea or severity of symptoms or length of hospitalization. The study was methodologically satisfactory.

Authors' conclusions

Oral furosemide cannot be recommended as treatment for transient tachypnea of the newborn and it should not be used unless additional data become available. The question remains as to whether intravenous furosemide given to the infant (or even to the mother before Caesarean section) might shorten the duration of the illness. As elective Caesarean section continues at a high level, these two interventions might be worthy of trials.

摘要

背景

使用furosemide治療新生兒-過性呼吸急促

新生兒-過性呼吸急促起因於肺部液體延遲清除,是足月兒轉入加護病房常見的原因,這種情況尤其常見於選擇性剖腹產。一般的療法包括給予適當氧氣,在某些病人會使用持續性呼吸道正壓,大部分的嬰兒會接受抗生素治療。加快肺部液體清除應該會減少症狀的時間和併發症。

目標

評估furosemide可否減少有新生兒-過性呼吸急促的足月兒氧氣治療時間、呼吸症狀和住院天數。

搜尋策略

我們搜尋Cochrane Controlled Trials Register、PubMed和EMBASE,原作者和相關的專家亦被諮詢。

選擇標準

隨機或半隨機控制試驗。少於7天大的嬰兒,週數大於37週且有新生兒-過性呼吸急促症狀者。在出生後7天使用靜脈注射、口服或吸入furosemide者和安慰組或無使用利尿劑組相比較。

資料收集與分析

兩位評論者分析了可能可納入研究的試驗品質並且由兩位評論者取得資料。

主要結論

搜尋只找到一個方法上合宜的隨機試驗。此試驗納入了50名新生兒一過性呼吸急促的嬰兒。嬰兒被隨機分派至口服furosemide 2mg/kg然後12小時後改為1m/kg或服用安慰劑兩組。前24小時服用furosemide組體重減輕較多,但沒有證據顯示於呼吸急促症狀時間或住院天數有明顯差異。這研究在方法學上堪稱滿意。

作者結論

口服furosemide無法建議使用在新生兒-過性呼吸急促的嬰兒,除非有更多的佐證資料。仍存在的問題是給予嬰兒靜脈注射furosemide (或甚至給予剖腹生產前的母親) 可能會縮短病程。考慮到選擇性剖腹產數目相當多,這兩個方法可能值得研究。

翻譯人

本摘要由馬偕醫院張龍翻譯。

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

總結

選擇性剖腹產的足月兒常發生費力和急促呼吸,需要氧氣治療約48小時。雖然症狀常多為短暫且不嚴重,但是仍可能需要轉入加護病房和母親分離及使用昂貴資源。Furosemide是強效的利尿劑,於別種情況可以減少肺部液體。我們發現只有一個研究 (有50個嬰兒) 曾試於此情況使用furosemide。藥物經由口服,無法改變症狀嚴重度或住院天數。給予靜脈furosemide,甚至於母親剖腹產之前,可能有更好的效果,或許值得研究。

Plain language summary

Furosemide for transient tachypnea of the newborn

It is common for full term infants born by elective Caesarean section to have laboured and rapid breathing (tachypnea) and to require oxygen for about 48 hours. Although transient and not usually serious, the condition requires admission to a neonatal intensive care unit and involves separation of mother and baby and use of expensive resources. Furosemide is a powerful diuretic which, in other circumstances, can reduce fluid in the lungs. We found only one trial (involving 50 infants) that had tested furosemide in this condition. The drug was given orally and made no difference to either the severity or duration of the illness or to length of hospitalization. Giving furosemide intravenously, or even to the mother before Caesarean, might have a more powerful effect and may merit investigation.

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