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Slaughter JL, Klebanoff MA, Hade EM. Estimating the effect of diuretics and inhaled corticosteroids for evolving bronchopulmonary dysplasia in preterm infants. Paediatr Perinat Epidemiol 2024. [PMID: 38192005 DOI: 10.1111/ppe.13038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 12/15/2023] [Accepted: 12/17/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND Off-label treatment of extremely preterm infants with diuretics and inhaled corticosteroids (ICS) for evolving bronchopulmonary dysplasia (BPD) is common. Their effectiveness in reducing mortality or BPD severity, and optimal treatment timing, are unclear. OBJECTIVES To determine whether diuretic treatment or ICS administration for infants with early evolving (between 10-27 days postnatal) and progressively evolving (28th-day-36th-week postnatal) BPD are independently associated with reduced mortality and moderate or severe BPD at 36-weeks postmenstrual age (PMA). METHODS We examined neonates born before 28 weeks' gestation and admitted to neonatal intensive care units on postnatal Day 0 between 2006 and 2016 using data collected during routine care recorded within the Paediatric Health Information System (PHIS). An early evolving BPD cohort consisted of infants treated with oxygen, positive pressure or mechanical ventilation at 10 days postnatal. The progressively evolving BPD cohort consisted of infants treated with these modalities at 28 days. In new users, we evaluated the effect of diuretic and ICS treatment on mortality or BPD severity at 36 weeks PMA, adjusting for time-dependent confounding by respiratory status using marginal structural models. RESULTS Early evolving BPD was present in 10,135 patients; progressively evolving BPD in 11,728. New diuretic exposure during early evolving BPD (adjusted risk ratio [aRR] 0.77, 95% confidence interval [CI] 0.65, 0.93) was associated with decreased mortality or moderate/severe BPD risk. New diuretics (aRR 0.86, 95% CI 0.75, 0.99) during progressively evolving BPD between 28-days-36-weeks PMA were less strongly associated with mortality or moderate/severe BPD reduction. There was no strong association for ICS in patients with early evolving (aRR: 1.40; 95% CI: 0.79, 2.51) or progressively evolving BPD (aRR 1.16, 95% CI 0.95, 1.49). CONCLUSION Diuretics, but not ICS, for evolving BPD were associated with mortality and BPD risk reduction.
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Affiliation(s)
- Jonathan L Slaughter
- Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio, USA
| | - Mark A Klebanoff
- Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio, USA
- Division of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Erinn M Hade
- Division of Biostatistics, Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
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Wright ML, Klamer BG, Bonachea E, Spencer JD, Slaughter JL, Mohamed TH. Positive fluid balance and diuretic therapy are associated with mechanical ventilation and mortality in preterm neonates in the first fourteen postnatal days. Pediatr Nephrol 2023:10.1007/s00467-022-05861-2. [PMID: 36598600 DOI: 10.1007/s00467-022-05861-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 12/13/2022] [Accepted: 12/13/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Fluid overload leads to poor neonatal outcomes. Diuretics may lower the rates of mechanical ventilation (MV) and mortality in neonates with fluid overload. METHODS This is a retrospective study of preterm neonates ≤ 36 weeks of gestational age (GA) in the first 14 postnatal days in a level IV NICU in 2014-2020. We evaluated the epidemiology of fluid balance in the first 14 postnatal days and its association with MV and mortality and studied the association of diuretics with fluid balance, MV, and mortality. RESULTS In 1383 included neonates, the overall median lowest and peak fluid balances were - 7.8% (IQR: - 11.7, - 4.6) and 8% (3, 16) on days 3 (2, 5) and 13 (5, 14), respectively. Fluid balance distribution varied significantly by GA. Peak fluid balance of ≥ 10% was associated with increased odds of MV on days 7 and 14 with highest odds ratios (OR) of MV in neonates with fluid balance ≥ 15%. Peak fluid balance of ≥ 15% was associated with the greatest odds of mortality. Diuretics were used more frequently in neonates with younger GA, smaller birthweight, positive fluid balance, and those on MV. CONCLUSIONS Positive fluid balance negatively impacts pulmonary status. The odds of MV and death increase significantly as peak fluid balance percentage increases in all GA groups. The impact of diuretics on MV and death in preterm neonates needs further evaluation. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Mariah L Wright
- Department of Pediatrics, The Ohio State University College of Medicine and Nationwide Children's Hospital, 700 Children's Dr, Columbus, OH, USA
| | - Brett G Klamer
- Division of Nephrology and Hypertension, Nationwide Children's Hospital, Columbus, OH, USA.,The Kidney and Urinary Tract Center, Nationwide Children's Hospital, Columbus, OH, USA.,Center for Biostatistics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Elizabeth Bonachea
- Department of Pediatrics, The Ohio State University College of Medicine and Nationwide Children's Hospital, 700 Children's Dr, Columbus, OH, USA
| | - John D Spencer
- Department of Pediatrics, The Ohio State University College of Medicine and Nationwide Children's Hospital, 700 Children's Dr, Columbus, OH, USA.,Division of Nephrology and Hypertension, Nationwide Children's Hospital, Columbus, OH, USA.,The Kidney and Urinary Tract Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Jonathan L Slaughter
- Department of Pediatrics, The Ohio State University College of Medicine and Nationwide Children's Hospital, 700 Children's Dr, Columbus, OH, USA.,The Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.,Division of Epidemiology, College of Public Health, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Tahagod H Mohamed
- Department of Pediatrics, The Ohio State University College of Medicine and Nationwide Children's Hospital, 700 Children's Dr, Columbus, OH, USA. .,Division of Nephrology and Hypertension, Nationwide Children's Hospital, Columbus, OH, USA. .,The Kidney and Urinary Tract Center, Nationwide Children's Hospital, Columbus, OH, USA.
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