Photo Credit: tangwitthayaphum

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 Journal of Pediatrics by Bamat et al. 

Researchers conducted a retrospective study to estimate the onset and extent of furosemide diuretic tolerance in infants with bronchopulmonary dysplasia (BPD) and examined whether thiazide co-administration influenced tolerance.  

They analyzed very preterm infants with BPD who received repeated-dose furosemide for 72 hours. Net fluid balance (total intake minus total output) was evaluated over the 3 days before and after exposure to estimate diuresis. The primary comparison analyzed fluid balance changes between the first and third 24-hour periods of furosemide use. A general linear model (GLM) was applied to assess within-subject fluid balance trends, incorporating thiazide co-administration as an interaction variable. Secondary analyses examined weight trajectories over time.  

The results showed that in 83 infants, the median fluid balance ranged from +43.6 to +52.7 ml/kg/d during the 3 days before furosemide exposure. After 24 hours of furosemide, fluid balance declined to a median of +29.1 ml/kg/d but increased to +47.5 ml/kg/d by the third 24-hour period, indicating tolerance (P < .001). Thiazide co-administration did not alter fluid balance changes during furosemide exposure at any time point. Weight significantly decreased in the first 24 hours post-furosemide and subsequently increased (P < .001).  

Investigators concluded that infants with BPD showed rapid diuretic tolerance to furosemide, necessitating careful consideration of therapeutic goals. 

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