Pharmacotherapy in Bronchopulmonary Dysplasia

Blanchard, P. W.; Brown, Tracey M.; Coates, Allan L.

doi:10.1016/s0095-5108(18)30739-5

Cited by 23 publications

(2 citation statements)

References 102 publications

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“…receive furosemide for prolonged periods of time, previous investigations of furosemide pharmacodynamics have focused on re sponse to initial doses [2][3][4][5], These studies have demonstrated a brisk furosemide-induced diuresis and natriuresis, despite the Chronic diuretic therapy with furosemide is widely used to improve pulmonary func tion in infants with bronchopulmonary dys plasia (BPD) [1], While these infants often One patient died of Staphylococcus aureus sepsis after 2 weeks of furosemide therapy. All other patients completed 3 weeks of therapy.…”

Section: Introductionmentioning

confidence: 99%

Renal Response to Furosemide in Very Low Birth Weight Infants during Chronic Administration

Mirochnick¹,

Miceli²,

Kramer³

et al. 1990

Dev Pharmacol Ther

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Renal response to furosemide following initial and chronic doses was investigated in premature infants with bronchopulmonary dysplasia. Seven infants (mean birth weight = 890 ± 216 g, mean gestational age at birth = 27.7 ± 2.6 weeks, mean postnatal age at the start of diuretic therapy = 2.7 ± 0.9 weeks) were studied. Twelve-hour urine collections were performed after the initial dose, and following chronic doses after 1 week and 3 weeks of therapy. Volume of each urine sample was measured and concentrations of furosemide, sodium and creatinine determined. Linear dose-response relationships were found between the logarithm of the urinary furosemide excretion rate and diuretic/natriuretic response (urine output and urinary sodium excretion rate). The furosemide excretion rate required to achieve midrange diuretic and natriuretic responses was significantly greater during chronic dosing than following initial doses, indicating a decrease in renal responsiveness to drug with sustained use. Increasing postconceptional age was associated with a decrease in initial responsiveness to furosemide. These data demonstrate that in premature infants renal sensitivity to furosemide decreases with chronic use as well as with increasing postconceptional age at the start of therapy. The decrease in renal sensitivity to drug with chronic use is of much greater magnitude, and appears to represent renal compensation for drug-induced diuresis and natriuresis.

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Section: Introductionmentioning

confidence: 99%

Renal Response to Furosemide in Very Low Birth Weight Infants during Chronic Administration

Mirochnick¹,

Miceli²,

Kramer³

et al. 1990

Dev Pharmacol Ther

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“…Current treatment aims to reverse the airway obstruction present during the course of the disease. Pharmacotherapy includes corticosteroids for the inhibition of chronic parenchymal inflammatory exudation (10), and diuretics for reduction of airway edema (11,12). Indications for the use of selective ß 2 -adrenergic agonists, such as salbutamol, in the treatment of very premature babies with BPD remain controversial.…”

Section: Introductionmentioning

confidence: 99%

Response of Very Premature Infants with Bronchopulmonary Dysplasia to Inhaled Salbutamol

Nguyen¹,

Fitzgerald²,

Davis³

2020

MJM

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Bronchopulmonary Dysplasia (BPD) is the most common chronic respiratory disease found in premature infants following prolonged supplemental oxygen and mechanical ventilation. Although salbutamol, a selective ß2 agonist, is known to relax the hypertrophied smooth muscles around the small airways in adults, earlier literature has suggested that neonates did not have enough peribronchial smooth muscle for constriction and thus lacked a bronchodilatory response to ß2 agonists. The present study was designed to determine whether infants of less than 32 weeks gestational age with elevated lung resistance were responsive to salbutamol. Nineteen premature infants (mean gestational age 26.0 +/- 2.1 weeks and mean birth weight 851.3 +/- 244.4 g) were recruited for the study. Immediately before and 30 minutes after the commencement of nebulized salbutamol administration, a minimum of 15 breaths were measured and analyzed for each patient. From this breath-by-breath analysis, the lung mechanics and Work of Breathing (WOB) were calculated. Results were then compared by paired t-tests. The use of salbutamol resulted in a significant improvement in airway resistance (p = 0.008) and tendency for impedance reduction. These results indicate that very premature infants (< 32 weeks) with BPD respond favorably to bronchodilators. Although the mechanism of action remains to be elucidated, salbutamol most probably achieves its effects through the relaxation of the hypertrophied peribronchial smooth muscle. Early intervention to relieve airway obstruction may promote early weaning from mechanical ventilation and diminish both duration and severity of BPD.

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