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Diuretics in BPD - which drugs & doses?


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In preterm infants > 3 weeks of age with CLD, a four-week treatment with thiazide and spironolactone improved lung compliance and reduced the need for furosemide. Thiazide and spironolactone decreased the risk of death and tended to decrease the risk for remaining intubated after eight weeks in infants who did not have access to corticosteroids, bronchodilators or aminophylline. However, there is little or no evidence to support any benefit of diuretic administration on need for ventilatory support, length of hospital stay, or long-term outcome in patients receiving current therapy.
from: http://www.nichd.nih.gov/cochrane/brion5/brion.htm.

In our NICU there is a trend towards prescribing less diuretics, furosemide as well as daily doses of thiazides and spironolactone. There is a trend to decrease fluid intake (to 130-150 ml/kg/day), while taking care to maximize caloric intake to promote growth. If we use diuretics typical doses are:

  • furosemide 1 mg/kg
  • thiazide 1 - 2 mg/kg in 1 or 2 dose(s) a day
  • spironolactin 1 -2 mg/kg in 1 or 2 dose(s) a day.

Best regards,

Christ-jan van Ganzewinkel

Neonatal Nurse Practitioner

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Thanks all for your input!

Maybe I should also share the our strategy: furosemid 1 mg/kd/dose once daily to start with, but we change to chlorotiazid (Diuril) 10-20 mg/kg x 2 and spironolactone 1-3 mg/kg x 1 if the baby is planned to stay on diuretics for longer periods.

Previously, we used much furosemid for longer periods of time, and my impression now is that we only rarely have problems with hypokalemia and nefrocalcinosis.

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Guest rlazarte

Lasix 1mg/kg/day for 3 days for acute effect, then Aldactazide 1mg/kg/dose twicw a day if indicated. However all diuretics are discontinued before discharge, or in presence of persistent hyponatremia/hypochloremia.

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  • 1 month later...

Hello!

I am very interested in this topic too. Tell me please, what is duration of course (one week, two weeks or until extubation)? Do you use diuretics with corticosteroids always or alone in any conditions? Whether there is a difference in your guidelines for BPD, is newborn ventilated or NCPAP?

Thank you

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Tell me please, what is duration of course (one week, two weeks or until extubation)? Do you use diuretics with corticosteroids always or alone in any conditions? Whether there is a difference in your guidelines for BPD, is newborn ventilated or NCPAP?

This is how we do it - not necessarily the right way to do it :)

Ill infants (on ventilator/HFOV) are usually given furosemid, 1-2 mg/kg/d, but after extubation many infants are switched to thiazides+spironolactone. We continue the therapy for quite some time, but usually before they are ready to start weaning off from CPAP (4-6 weeks are typical).

As many have pointed out - it is questionable whether to use diuretics at all. But, we still do use them.

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  • 1 month later...
Thanks all for your input!

Maybe I should also share the our strategy: furosemid 1 mg/kd/dose once daily to start with, but we change to chlorotiazid (Diuril) 10-20 mg/kg x 2 and spironolactone 1-3 mg/kg x 1 if the baby is planned to stay on diuretics for longer periods.

Previously, we used much furosemid for longer periods of time, and my impression now is that we only rarely have problems with hypokalemia and nefrocalcinosis.

hi, in our unit we do not use diuretics routinely, as we tend to extubate early and use bubble nasal c.p.a.p with or without surfactant,selectivly, with lung defence strategy,,anyhow we use diuretics(lasix,then thiazide+spirolactone) only in case of pending h.f or obviouse water retention, wet lung fields,or renal causes, but not aroutine for prevention of c.l.d,i cant see beneficial effect on long of stay or r.o.p or time of respiratory support,thanks alot

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