Newswise — COLUMBUS, Ohio. Even though there is little data to support the extended use of diuretic medications to help reduce fluid build-up in the lungs of premature infants, researchers at Nationwide Children’s Hospital have found significant variation in how babies receive these medications at hospitals across the nation.
“There are minimal data on the efficacy or side effects of the extended use of diuretics in preterm infants needing breathing support, yet long-term use is routine among the nation’s neonatal intensive care units,” said Jonathan Slaughter, MD, MPH, principal investigator in the Center for Perinatal Research and a neonatologist at Nationwide Children’s Hospital.
Slaughter’s study, published in the March issue of Pediatrics, evaluated data gathered during a 54-month period from 35 US children’s hospitals involving 1429 infants with Bronchopulmonary dysplasia, or BPD.
BPD is a multifaceted inflammatory disease that affects low birth weight, preterm infants who spend long periods of time on oxygen and mechanical ventilation. The use of diuretic medications for preterm infants with BPD has been a common regimen for more than 30 years, and helps reduce fluid that could further clog inflamed airways.
Researchers found that among hospitals with at least 15 BPD patients, the percentage of infants receiving a diuretic course of longer than five days ranged from 4 percent to 86 percent.
Overall, 86 percent of the infants in the study received a diuretic, with 84 percent of those infants receiving at least one course of the drug for five days or less, and 40 percent receiving courses of medication for longer than five consecutive days.
“We found that the length of time infants required mechanical ventilation was the greatest predictor of diuretic medication use,” explained. “On average, among infants that develop BPD, courses of diuretic use of five days or less predominate in the first month of life, with more than five days of diuretic use more common thereafter.”
Slaughter’s findings are consistent with a separate study of 400 neonatologists examining their clinical decisions to use diuretics. That study showed that 66 percent of the respondents expected decreased ventilator days and 59 percent expected decreased length of stay for the patient with long-term use of diuretics.
“Our baseline findings can serve as the foundation for a prospective comparative effectiveness study to determine whether long-term use of diuretics in BPD patients is truly beneficial,” said Slaughter, who is also an assistant professor of pediatrics at The Ohio State University College of Medicine. “Additionally, the variations also indicate a real need for guidelines around the use of diuretics in this patient population.”
Along with asthma and cystic fibrosis, BPD is one of the most common chronic lung diseases in children. According to the National Heart, Lung, and Blood Institute (NHLBI), between 5,000 and 10,000 cases of BPD occur every year in the United States. While most cases of BPD resolve, some children experience lifelong lung issues because of BPD.
“We have a critical need for a better understanding of the benefits and side effects in diuretic-exposed patients. If long-term diuretic use is shown to be advantageous for BPD patients, more research will be needed to determine which type of diuretics provide the most benefit and the lowest long-term risks,” added Slaughter.
This research was funded by the National Center for Advancing Translational Sciences (NCATS) at the National Institutes of Health via the Ohio State University Center for Clinical and Translational Sciences (CCTS) KL2 Career Development Program, and also by the Agency for Healthcare Research and Quality (AHRQ).
About The Ohio State University Center for Clinical and Translational ScienceDedicated to turning the scientific discoveries of today into the life-changing health innovations of tomorrow, The Ohio State University Center for Clinical and Translational Science (CCTS) is a collaboration of experts including scientists and clinicians from six Ohio State Health Science Colleges, Ohio State’s Wexner Medical Center and College of Medicine, and Nationwide Children’s Hospital. Funded by a multi-year Clinical and Translational Science Award (CTSA) from the National Institutes of Health, OSU CCTS provides financial, organizational and educational support to biomedical researchers as well as opportunities for community members to participate in credible and valuable research. The CCTS is led by Rebecca Jackson, M.D., Director of the CCTS and associate dean of research at Ohio State. For more information, visit http://ccts.osu.edu.
About Nationwide Children’s HospitalRanked 7th of only 12 children’s hospitals in U.S.News & World Report’s 2012-13 “America’s Best Children’s Hospitals” and among the Top 10 on Parents magazine’s 2013 “Best Children’s Hospitals” lists, Nationwide Children’s Hospital is one of the nation’s largest not-for-profit freestanding pediatric healthcare networks providing care for infants, children, adolescents and adult patients with congenital disease. As home to the Department of Pediatrics of The Ohio State University College of Medicine, Nationwide Children’s Hospital faculty train the next generation of pediatricians, scientists and pediatric specialists. The Research Institute at Nationwide Children’s Hospital is one of the top 10 National Institutes of Health-funded free-standing pediatric research facilities in the U.S., supporting basic, clinical, translational and health services research at Nationwide Children’s Hospital. In June 2012, the hospital celebrated completion of the largest pediatric expansion project in United States history including the addition of a third research building. All three research buildings include approximately 525,000 square feet dedicated to research. More information is available at NationwideChildrens.org/Research.
About the Clinical and Translational Science Awards Launched in 2006 by the NIH, and currently residing in the National Center for the Advancement of Translational Sciences (NCATS), the Clinical and Translational Science Awards (CTSA) program created academic homes for clinical and translational science at research institutions across the country. The CTSA’s primary goal is to accelerate discoveries towards better human health by speeding up the time it takes for basic science to turn into useable therapeutics and to train the next generation of clinicians and translational researchers.
The Ohio State University Center for Clinical and Translational Science (CCTS) is funded by the National Institutes of Health (NIH) Clinical and Translational Science Award (CTSA) program (grants 8UL1TR000090-05, 8KL2TR000112-05, and 8TL1TR000091-05) The CTSA program is led by the NIH’s National Center for Advancing Translational Sciences (NCATS). The content of this release is solely the responsibility of the CCTS and does not necessarily represent the official views of the NIH.
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