Evaluation of furosemide regimens in neonates treated with extracorporeal membrane oxygenation

Vorst, Maria M J van der; Wildschut, Enno D.; Houmes, RJ; Gischler, Saskia J.; Holthe, Joana E. Kist-van; Burggraaf, Jacobus; Heijden, Albert J. van der; Tibboel, Dick

doi:10.1186/cc5115

Cited by 25 publications

(8 citation statements)

References 22 publications

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“…Van der Vorst et al [94] stated that tolerance of furosemide effect does not develop with prolonged diuretic exposure. It has been suggested that the tolerance to furosemide can be induced through different but complementary homeostatic mechanisms in the kidney [95,96].…”

Section: Resultsmentioning

confidence: 99%

“…There are no indications that tolerance develops towards the diuretic effect of furosemide in hemodynamically unstable infants with volume overload after cardiac surgery with cardiopulmonary bypass, who are treated with a relatively aggressive diuretic regimen with furosemide. It is unlikely that the high furosemide dose was associated with renal toxicity [94]. Relatively high furosemide doses did not result in metabolic alkalosis.…”

Section: Resultsmentioning

confidence: 99%

“…Van der Vorst et al [9] evaluated the furosemide regimen in neonates treated with ECMO. Thirty-one infants with a mean gestational age of 40 weeks and a mean postnatal age of 1 day (range 0 to 16 days) and median body weight of 3.5 kg were enrolled in the study.…”

Section: Resultsmentioning

confidence: 99%

“…van der Vorst et al [9] observed that the dose of the continuous intravenous infusion of furosemide varied from 0.02 to 0.17 mg/kg/h, and that 39% of the patients received additional diuretic. Although the urine output was satisfactory in patients studied, the use of additional diuretic suggests that the applied infusion rates were not optimal.…”

Section: Resultsmentioning

confidence: 99%

“…The most common diagnosis for which ECMO is performed are diaphragmatic hernia, meconium aspiration syndrome, and pneumonia [8]. The variable renal function, and the altered furosemide pharmacokinetics, that range from 0.02 to 0.17 mg/kg/h [9], make the dosing schedule of furosemide for ECMO largely empirical. Furosemide may be administered by inhalation to preterm infants with chronic lung disease [10] to improve pulmonary mechanics [11].…”

Section: Introductionmentioning

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%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Clinical Pharmacology of Furosemide in Neonates: A Review

Pacifici

2013

Pharmaceuticals

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Use of Continuous‐Infusion Loop Diuretics in Critically Ill Children

2014

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Loop diuretics are commonly used in critically ill children to achieve appropriate fluid balance. They are often administered as a continuous intravenous infusion (CI) in hemodynamically unstable children because of fewer alterations in central venous pressure, oxygen saturation, and heart rate compared with scheduled intermittent dosing. During the past few years, however, drug shortages have been reported for bumetanide, torsemide, and furosemide. Therefore, to explore the use of alternative agents for CI, we performed a literature search to identify articles evaluating the use of furosemide, bumetanide, ethacrynic acid, and torsemide CI in critically ill children. The search was limited to English-language articles in the MEDLINE (1946-December 2013), EMBASE (1980-December 2013), and International Pharmaceutical Abstracts (1970-December 2013) databases and the Cochrane Database of Systematic Reviews (2005-December 2013). Reference citations from relevant articles were also reviewed. A total of 10 reports representing 173 pediatric patients were included in the analysis. Most of the reports provided evidence for furosemide, and no reports with torsemide were identified. Wide variability in CI dosing was reported in these studies. When selecting the loop diuretic CI for critically ill patients, clinicians should consider their adverse-event profiles, compatibility with other concomitant intravenous infusions, and pharmacoeconomics. Fluid balance and urine output should be monitored routinely to ensure appropriate response. The lowest initial dose should be used to achieve an appropriate fluid balance and target urine output of 1-3 ml/kg/hour while limiting the likelihood of toxicity.

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