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Stefan Johansson

Diuretics in BPD - which drugs & doses?

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We use Lasix or Furosemide 1mg/kg/dose once a day initially and if needed for long term, change to Aldactazide 1mg/kg/dose of Spiranolactone and Hydrochlorothiazide combination once a day or q12h. Need to watch for hyponatremia. The pharmacy makes a suspension of Aldactazide.

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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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usually we start Furosemide 1mg/kg/day (for2-3 days) simultaneously with hydrochlorotizide 1-3mg Q12hr+ spironolactone 1-2mg Q24hr (for 2-3weeks)

Dr sufwan alomar

fellow

HMC

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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 urai06

I usually use Laxic just only for need rapid response but I use chlorothiazide and spinolactone in long term use.

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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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We tend to use Spironolactone 1mg/kg Chlorothiazide 10mg/kg twice a day, furosemide in more acute scenarios

Best wishes

Alistair

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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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Recent studies showed no benefit and this is my observation too. My advice is not to use diuretics unless in special situations like heart failure.

Thanks

Dr. Yaser Elsaba

SSR

Dubai hospital

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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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We were not using it and still getting away well. questionable efficacy with lot of nephrocalcinosis..

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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.

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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in our NICU we use hydrochlorotizide 1-2mg/kg Q12hr + spironolactone 0,5-1,5 mg/kg Q12hr until no more O2 or nCPAP dependence.

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