286 - Diuretic Exposure and Correlation with Respiratory Severity Score at 36 Weeks Gestational Age in Preterm Infants Born at High Risk for Development of Severe Bronchopulmonary Dysplasia

Sunday, April 30, 2023

3:30 PM – 6:00 PM ET

Poster Number: 286
Publication Number: 286.344

Page M. Queener, Children's Hospital Colorado, Denver, CO, United States; Blair W. Weikel, University of Colorado Anschutz Medical Campus, Aurora, CO, United States; Erica M.. Wymore, University of Colorado School of Medicine, Aurora, CO, United States; Satya Houin, University of Colorado School of Medicine, Denver, CO, United States; John P. Kinsella, University of Colorado School of Medicine, Highlands Ranch, CO, United States; Kathleen E. Hannan, University of Colorado School of Medicine, Denver, CO, United States; Stephanie L. Bourque, University of Colorado School of Medicine, Denver, CO, United States; Erica W. Mandell, University of Colorado School of Medicine, Aurora, CO, United States; Emma L. Ross, Childrens Hospital Colorado, Aurora, CO, United States; Stephanie Chassen, University of Colorado, Aurora, CO, United States

Presenting Author(s)

Page M. Queener, PharmD (she/her/hers)

PGY-1 Pharmacy Resident
Children's Hospital Colorado
Denver, Colorado, United States

Background: Preterm infants born at less than 29 weeks with invasive and non-invasive positive pressure needs at 6 weeks of age are at high risk for development of bronchopulmonary dysplasia (BPD). Many preterm infants with sustained positive pressure needs are treated with prolonged diuretic therapy despite a paucity of literature to support, such as any clinical benefit of decreased fraction of inspired oxygen (FiO₂) or respiratory support at 36 weeks corrected gestational age (CGA). Additionally, diuretic use in premature infants can lead ototoxicity, electrolyte disturbances, metabolic bone disease, and renal injury.

Objective: To determine cumulative diuretic exposure and its correlation with respiratory severity score (RSS), FiO₂, incidence of diuretic prescription at discharge, and adverse outcomes of diuretic use.

Design/Methods: This single-center cohort included infants born at less than 29 weeks gestation with non-invasive or invasive ventilation positive pressure needs at 6 weeks of age who received diuretics prior to 48 weeks CGA or discharge, admitted between January 2017 and December 2021. We excluded those structural heart disease, hydrops fetalis, other major congenital abnormalities, or transferred to the institution after 6 weeks of age. Linear regression was used to compare cumulative diuretic dose and outcomes of interest.

Results: Sixty-four patients met inclusion criteria with a median gestational age of 25 weeks (IQR 24, 26.5) and median birth weight of 742.5 grams (IQR 645, 902.5). There was no correlation between cumulative diuretic exposure and RSS at 36 weeks CGA for furosemide (p=0.09) or chlorothiazide (p=0.06). No improvement in FiO₂ one month after the first diuretic dose for furosemide (p=0.23) or chlorothiazide (p=0.72), regardless of cumulative exposure. There was no statistical correlation between cumulative diuretic dose and incidence of discharge prescription for furosemide (OR 1.02 [0.97, 1.06]) or chlorothiazide (OR 0.99 [0.99, 1.00]). At discharge, 8 (13%) had a diagnosis of osteopenia, 1 (2%) had nephrolithiasis, and 9 (14%) failed a hearing screen.

Conclusion(s):

We did not find a statistically significant improvement in RSS score or FiO2 requirements with increasing cumulative diuretic exposure in preterm infants with prolonged positive pressure requirements. Additionally, the lack of correlation between cumulative inpatient diuretic exposure and diuretic prescription at discharge highlights the variability of diuretic use in this population.