The following is a summary of “Diuretic Tolerance to Repeated-Dose Furosemide in Infants Born Very Preterm with Bronchopulmonary Dysplasia,” published in the March 2024 issue of Pediatrics by Bamat, et al.

For a study, researchers sought to evaluate the presence and timing of furosemide diuretic tolerance in infants diagnosed with bronchopulmonary dysplasia (BPD) and to investigate whether co-administration of thiazides modifies this tolerance.

They conducted a retrospective cohort study involving very preterm infants diagnosed with BPD who were exposed to repeated doses of furosemide for 72 hours. They utilized net fluid balance (total intake minus total output) as a surrogate measure of diuresis in the 3 days preceding and following furosemide exposure. The primary comparison focused on the difference in fluid balance between the first and third 24 hours of furosemide administration. A general linear model was employed for repeated measures of fluid balance over time within subjects, with thiazide co-administration as an interaction variable. Secondary analyses included assessing weight trajectories over time.

Among 83 infants included in the study, the median fluid balance ranged from +43.6 to +52.7 ml/kg/d in the 3 days before furosemide exposure. Following furosemide administration, median fluid balance decreased to +29.1 ml/kg/d in the first 24 hours but subsequently increased to +47.5 ml/kg/d by the third 24-hour interval, indicative of tolerance (P < .001). Thiazide co-administration did not alter the change in fluid balance during furosemide exposure for any period. Weight exhibited a significant decrease in the initial 24 hours after furosemide administration, followed by an increase thereafter (P < .001).

The findings indicated that the net fluid balance response to repeated doses of furosemide diminishes rapidly in infants with BPD, suggesting the development of diuretic tolerance. The insight underscored the importance for clinicians to consider when establishing therapeutic goals for infants. Further research endeavors are warranted to establish safe and efficacious furosemide dosage strategies in this patient population.

Reference: jpeds.com/article/S0022-3476(23)00677-7/abstract