Diuretic use in infants with developing or established chronic lung disease: A practice looking for evidence

Aim The objective was to assess respiratory efficacy of hydrochlorothiazide and spironolactone and ascertain any adverse effects. Methods Data from 2014 to 2018 was analysed for infants <28 weeks' gestational age (GA) administered oral diuretics. Impact on respiratory support, weight gain and electrolyte status was assessed as a pre-post intervention study. Results Of 491 infants, 117 (24%) were administered diuretics for evolving or established bronchopulmonary dysplasia. GA and birthweight of the cohort were 25.7 +/- 1.1 weeks and 779 +/- 172 g, respectively. Median (interquartile range) chronological age and GA at the start of diuretics was 45 (22, 62) days and 32.1 (30.1, 35.1) weeks, respectively. In 71/117 (61%) infants, diuretics were started at <36 weeks GA. Of them 63 (88.7%) went on to develop bronchopulmonary dysplasia. Median duration of diuretics was 38 (18-52) days. Modest improvement was noted in respiratory parameters (ventilator pressure (cm of H2O), 8.8 +/- 0.4 vs. 8.8 +/- 0.5, P = 0.39, oxygen requirement (%), 32 +/- 1 vs. 30 +/- 1, P = 0.07 and pO(2) (mm Hg) 34.5 +/- 1.3 vs. 36.6 +/- 1, P = 0.04. Ninety-eight (84%) infants developed hyponatraemia (<135 mmol/L); sodium supplements were administered in 58/98 (59%) infants. In one third infants, phosphate levels dropped below 1.8 mmol/L, needing supplementation. Weight gain (g/kg/day) slowed down significantly (18.2 +/- 2.1 to 10 +/- 2.9, P = <0.001). Conclusions Use of diuretics was associated with modest improvements in respiratory support requirements but was associated with significant electrolyte abnormalities and slowdown in weight gain (or weight loss).