Diuretics use in the management of bronchopulmonary dysplasia in preterm infants: A systematic review

Ó Briain, Eoin; Byrne, Aisling O.; Dowling, Jack; Kiernan, Julia; Lynch, James Carlo Rio; Alomairi, Lulwa; Coyle, Lauren; Mulkerrin, Lorcan; Mockler, David; Fitzgerald, Geraldine; Rehman, Liqa Ur; Semova, Gergana; Isweisi, Eman; O'Sullivan, Anne; O'Connor, Pamela; Mulligan, Kevin; Branagan, Aoife; Roche, Edna; Meehan, Judith; Molloy, Eleanor

doi:10.1111/apa.17093

Cited by 5 publications

References 28 publications

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Bronchopulmonary dysplasia and diuretic use in an outpatient setting

McGlynn,

Martin,

Aoyama

et al. 2024

Pediatric Pulmonology

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IntroductionDuring Neonatal Intensive Care Unit hospitalization, children born preterm with bronchopulmonary dysplasia (BPD) are frequently prescribed diuretics for chronic respiratory symptoms. However, less is known about diuretic use and weaning in an outpatient setting. The study sought to characterize clinical features associated with outpatient diuretic use and timing of diuretic weaning in children with BPD.MethodsData was obtained by chart review from 1224 registry participants born <32 weeks gestation, discharged between 2008 and 2023 and recruited from outpatient BPD clinics at Johns Hopkins Children's Center and the Children's Hospital of Philadelphia (97.4% diagnosed with BPD). Data was analyzed using Chi‐square tests, t‐tests, and ANOVA tests.ResultsChildren on diuretics at their first pulmonary visit (n = 737) were more likely to have lower birth weights, earlier gestational age, and severe BPD compared to those not on diuretics (n = 487). Of those prescribed diuretics, most children were on a thiazide alone (46.4%) or a thiazide and a potassium sparing agent (44.8%) with a minority prescribed loop diuretics alone (3.3%) or loop diuretic combinations (4.7%). Most children weaned off diuretics by 2 years of age. Public insurance, early gestational age, technology dependence, home supplemental oxygen use and loop diuretics were associated with slower diuretic weaning.ConclusionOutpatient diuretic use is common in children with BPD, however variations in diuretic use and diuretic combinations exist across centers. Time to wean off home supplemental oxygen is similar between children on one diuretic compared to none. Timing of outpatient diuretic weaning is influenced by diuretic class, respiratory support, and co‐morbidities.

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Bronchopulmonary dysplasia and diuretic use in an outpatient setting

McGlynn,

Martin,

Aoyama

et al. 2024

Pediatric Pulmonology

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Bronchiolitis: evidence-based management in high-risk infants in the intensive care setting

Walsh,

Costello,

DiCosimo

et al. 2024

Pediatr Res

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Aim Systematically review the management of infants with severe bronchiolitis in a paediatric intensive care unit (PICU) setting with a focus on high-risk infants to identify gaps in evidence-based knowledge. Methods This systematic review utilised Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA-P) to examine the literature on the PICU management of bronchiolitis in infants <24 months old. Three databases, Embase, PubMed and Medline, were searched and higher levels of evidence I, II and III were included. Results There were 455 papers reviewed and 26 met the inclusion criteria. Furthermore, 19 of these studied respiratory interventions such as positive airway pressure and oxygen delivery. The remaining 7 examined: erythropoietin, caffeine, dexamethasone, protein supplementation, ribavirin, respiratory syncytial virus immune globulin, or diuretic therapy. Of the 26 studies, 20 excluded infants with high-risk conditions. Therapies showing favourable outcomes included Heliox, prophylactic dexamethasone pre-extubation, protein supplementation, and diuretic use. Conclusions Clinical trials for bronchiolitis management frequently exclude high-risk children. Innovative study design in the future may improve access to clinical trials for the management of bronchiolitis in high-risk infants in a PICU setting. Impact Clinical trials for bronchiolitis management frequently exclude high-risk children. We review the evidence base for the management of an under-investigated patient demographic in the setting of acute bronchiolitis. Randomised controlled trials are needed to determine the efficacy of management strategies for bronchiolitis in high-risk infants in a paediatric intensive care setting.

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