Scolaris Content Display Scolaris Content Display

Diuretics for respiratory distress syndrome in preterm infants

Contraer todo Desplegar todo

Abstract

disponible en

Background

Lung edema may complicate respiratory distress syndrome (RDS) in preterm infants.

Objectives

The aim of this review was to assess the risks and benefits of diuretic administration in preterm infants with RDS.

Search methods

The standard search method of the Cochrane Neonatal Review Group was used. The Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library), MEDLINE and EMBASE were searched. These searches were updated in April 2003, March 2007, January 2011. In addition, the abstract books of the American Thoracic Society and Society for Pediatric Research were searched. MEDLINE and CENTRAL search was conducted using the keyword "Respiratory Distress Syndrome" alone, to find studies of medications recently classified as diuretics, such as theophylline. In addition, EMBASE, controlled‐trials.com and clinicaltrials.gov searches were completed in January 2011. MEDLINE search updated to August 2011.

Selection criteria

Trials were included in which preterm infants with RDS and less than five days of age were randomly allocated to diuretic administration. Of those trials, studies were only included in which at least one of the following outcomes measures was evaluated: mortality, patent ductus arteriosus, hypovolemic shock, intraventricular hemorrhage, renal failure, duration of oxygen supplementation, duration of mechanical ventilation, need for oxygen supplementation at 28 days of life, oxygen supplementation at 36 weeks of postmenstrual age (gestational age + postnatal age), length of stay, number of rehospitalizations during the first year of life, and neurodevelopmental outcome.

Data collection and analysis

The standard method for the Cochrane Collaboration, which is described in the Cochrane Collaboration Handbook, was used. Two investigators extracted, assessed and coded separately all data for each study. Any disagreement was resolved by discussion.

Main results

Seven studies met inclusion criteria. Six studies using furosemide were done before the current era of prenatal steroids, surfactant and fluid restriction. Furosemide administration had no long‐term benefits. Furosemide‐induced transient improvement in pulmonary function did not outweigh an increased risk for patent ductus arteriosus and for hemodynamic instability. In one recent study, theophylline had no long‐term benefits. Theophylline significantly decreased the risk of oligoanuria and transiently increased renal function, but did not significantly affect renal function at discharge or other outcomes.

Authors' conclusions

There are no data to support routine administration of furosemide in preterm infants with RDS. Elective administration of furosemide to any patient with RDS should be carefully weighed against the risk of precipitating hypovolemia or developing a symptomatic patent ductus arteriosus. There are not enough data to support routine administration of low‐dose theophylline in preterm infants with RDS.

PICO

Population
Intervention
Comparison
Outcome

El uso y la enseñanza del modelo PICO están muy extendidos en el ámbito de la atención sanitaria basada en la evidencia para formular preguntas y estrategias de búsqueda y para caracterizar estudios o metanálisis clínicos. PICO son las siglas en inglés de cuatro posibles componentes de una pregunta de investigación: paciente, población o problema; intervención; comparación; desenlace (outcome).

Para saber más sobre el uso del modelo PICO, puede consultar el Manual Cochrane.

Plain language summary

disponible en

Diuretics for respiratory distress syndrome in preterm infants

There is not enough data to support the routine use of diuretics for respiratory distress syndrome in newborn babies. Diuretics are drugs that increase the production of urine by encouraging salt and water to be released from the kidneys. When newborn babies have respiratory distress syndrome (RDS), their lungs may also contain excess fluid that can cause breathing problems. Babies with RDS sometimes may also have a reduced urine output. Using diuretics in these babies may improve lung or kidney function transiently, but may also increase cardiovascular complications. The review of trials did not find enough evidence supporting the routine use of diuretics in these infants.