Effect of Furosemide on Ductal Closure and Renal Function in Indomethacin-Treated Preterm Infants during the Early Neonatal Period

Lee, Byong Sop; Byun, Shin Yun; Chung, Myung‐Sub; Chang, Ji Young; Kim, Hee Young; Kim, Ellen Ai‐Rhan; Kim, Ki-Soo; Pi, Soo Young

doi:10.1159/000289206

Cited by 40 publications

(21 citation statements)

References 57 publications

(43 reference statements)

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“…Lee et al [108] identified the effects of furosemide, after indomethacin administration on the rate of patent ductus arteriosus closure and renal function, in preterm infants with a gestational age <34 weeks and a birthweight <2,000 g receiving indomethacin therapy (one course: 0.2–0.1–0.1 mg/kg every 12 h) mostly started <48 h after birth. Thirty-five infants received furosemide (1 mg/kg) and 33 infants were the controls.…”

Section: Resultsmentioning

confidence: 99%

“…The incidence of acute renal failure (serum creatinine >1.6 mg/dL) was greater in the furosemide group (59%) than in the control group (10%; p < 0.001). Lee et al [108] conclude that the use of furosemide in combination with indomethacin increased the incidence of acute renal failure but did not affect the patent ductus closure rate in preterm infants.…”

Section: Resultsmentioning

confidence: 99%

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Clinical Pharmacology of Furosemide in Neonates: A Review

Pacifici

2013

Pharmaceuticals

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Furosemide is the diuretic most used in newborn infants. It blocks the Na+-K+-2Cl− symporter in the thick ascending limb of the loop of Henle increasing urinary excretion of Na+ and Cl−. This article aimed to review the published data on the clinical pharmacology of furosemide in neonates to provide a critical, comprehensive, authoritative and, updated survey on the metabolism, pharmacokinetics, pharmacodynamics and side-effects of furosemide in neonates. The bibliographic search was performed using PubMed and EMBASE databases as search engines; January 2013 was the cutoff point. Furosemide half-life (t1/2) is 6 to 20-fold longer, clearance (Cl) is 1.2 to 14-fold smaller and volume of distribution (Vd) is 1.3 to 6-fold larger than the adult values. t1/2 shortens and Cl increases as the neonatal maturation proceeds. Continuous intravenous infusion of furosemide yields more controlled diuresis than the intermittent intravenous infusion. Furosemide may be administered by inhalation to infants with chronic lung disease to improve pulmonary mechanics. Furosemide stimulates prostaglandin E2 synthesis, a potent dilator of the patent ductus arteriosus, and the administration of furosemide to any preterm infants should be carefully weighed against the risk of precipitation of a symptomatic patent ductus arteriosus. Infants with low birthweight treated with chronic furosemide are at risk for the development of intra-renal calcifications.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Clinical Pharmacology of Furosemide in Neonates: A Review

Pacifici

2013

Pharmaceuticals

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“…Furosemide administration and phototherapy also have been reported to increase the incidence of PDA (19, 20); however, more recent studies have not found this to be the case (21, 22). Administration of exogenous surfactant can alter the presentation of a PDA.…”

Section: Incidence Of Spontaneous Ductus Closurementioning

confidence: 99%

Patent Ductus Arteriosus: Are Current Neonatal Treatment Options Better or Worse Than No Treatment at All?

Clyman

Couto

Murphy

2012

Seminars in Perinatology

241

176

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Although a moderate-size PDA needs to be closed by the time a child is 1–2 years old, there is great uncertainty about whether it needs to be closed during the neonatal period. While 95% of neonatologists believe that a moderate-size PDA should be closed if it persists in infants (born before 28 weeks) who still require mechanical ventilation, the number that treat a PDA when it occurs in infants that do not require mechanical ventilation varies widely. Both the high likelihood of spontaneous ductus closure and the absence of RCTs, specifically addressing the risks and benefits of neonatal ductus closure, adds to the current uncertainty. New information suggests that early pharmacologic treatment has several important short-term benefits for the preterm newborn. On the other hand, ductus ligation, while eliminating the detrimental effects of a PDA on lung development, may create its own set of morbidities that counteract many of the benefits derived from ductus closure.

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“…In a study of 68 preterm infants treated with indomethacin and were randomly assigned to receive furosemide (1 mg/kg) or placebo, there was no difference in the rate PDA closure, neonatal morbidity, or mortality in the furosemide-treated group [120]. …”

Section: How To Treat?mentioning

confidence: 99%

Patent Ductus Arteriosus in Preterm Infants: Do We Have the Right Answers?

Abdel‐Hady

Nasef

Shabaan

et al. 2013

BioMed Research International

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Patent ductus arteriosus (PDA) is a common clinical condition in preterm infants. Preterm newborns with PDA are at greater risk for several morbidities, including higher rates of bronchopulmonary dysplasia (BPD), decreased perfusion of vital organs, and mortality. Therefore, cyclooxygenase (COX) inhibitors and surgical interventions for ligation of PDA are widely used. However, these interventions were reported to be associated with side effects. In the absence of clear restricted rules for application of these interventions, different strategies are adopted by neonatologists. Three different approaches have been investigated including prophylactic treatment shortly after birth irrespective of the state of PDA, presymptomatic treatment using echocardiography at variable postnatal ages to select infants for treatment prior to the duct becoming clinically significant, and symptomatic treatment once PDA becomes clinically apparent or hemodynamically significant. Future appropriately designed randomized controlled trials (RCTs) to refine selection of patients for medical and surgical treatments should be conducted. Waiting for new evidence, it seems wise to employ available clinical and echocardiographic parameters of a hemodynamically significant (HS) PDA to select patients who are candidates for medical treatment. Surgical ligation of PDA could be used as a back-up tool for those patients who failed medical treatment and continued to have hemodynamic compromise.

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Effect of Furosemide on Ductal Closure and Renal Function in Indomethacin-Treated Preterm Infants during the Early Neonatal Period

Cited by 40 publications

References 57 publications

Clinical Pharmacology of Furosemide in Neonates: A Review

Clinical Pharmacology of Furosemide in Neonates: A Review

Patent Ductus Arteriosus: Are Current Neonatal Treatment Options Better or Worse Than No Treatment at All?

Patent Ductus Arteriosus in Preterm Infants: Do We Have the Right Answers?

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