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Use of diuretics for BPD increases the risk of metabolic bone disease in preterm infants

Maria Abraham, Dr. Snigdha Bhatia, Dr. Sunil Jain, Dr. Bruce Niebuhr

University of Texas Medical Branch at Galveston

Purpose of Study: Increased survival of preterm infants has led to an increased incidence of bronchopulmonary dysplasia (BPD). Diuretics are routinely used in the management of BPD. Use of diuretics in the management of BPD is controversial. Preterm infants are at increased risk of developing metabolic bone disease (MBD). MBD is multifactorial; there is insufficient data to assess the effect of diuretics on MBD in preterm infants. We hypothesize the study will show there is an increased risk of developing MBD in preterm infants with BPD who are on diuretics.

Methods Used: After IRB approval, in a retrospective study, we included all infants born at UTMB, Galveston who were <30 weeks gestation and birth weight <1500 grams between January 2017 to August 2018 (20 months). All infants were divided into diuretics and control group. Diuretic group infants received diuretics for BPD. Control group did not receive diuretics. BPD was defined as infants requiring respiratory support at 36 weeks post menstrual age and diuretics use was hydrochlorothiazide + spironolactone for at least 7 days. All infants were assessed for development of MBD. MBD was defined as parathyroid hormone (PTH) >100 pg/mL. We also assessed if diuretics helped to improve the respiratory status. Data was analyzed using SPSS, Chi Square Test and T test and p <0.05 were considered significant

Summary of Results: 154 infants were included in the study. Mean gestational age was 27.6 +2.7 weeks; mean birth weight 999 +312 grams. There were 53 (35%) in BPD+Diuretic group and 101 infants (65%) in control group. 37% V/S 21% (p<0.05) of infants in the BPD+Diuretics group developed MBD. 87% V/S 13% (p<0.001) of infants with BPD were treated with diuretics. 55% V/S 45% (p<0.05) of infants with BPD develop MBD. When comparing the respiratory response to diuretics, diuretics did not improve the respiratory status. At the same time, we found infants given diuretics remained on ventilation for longer (p=0.002).

Conclusion:This study showed infants who were treated with diuretics for BPD are more likely to develop MBD without any significant improvement in respiratory status. Diuretics should be used with caution and monitored closely for MBD. Further studies may be useful to set standardized guidelines for diuretic use.

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