Acute Responses to Diuretic Therapy in Extremely Low Gestational Age Newborns: Results from the Prematurity and Respiratory Outcomes Program Cohort Study

Prematurity and Respiratory Outcomes Program, Carol J. Blaisdell, James Troendle, Anne Zajicek, Claire Chougnet, James M. Greenberg, William Hardie, Alan H. Jobe, Karen McDowell, Thomas Ferkol, Mark R. Holland, James Kemp, Philip T. Levy, Phillip Tarr, Gautam K. Singh, Barbara Warner, Aaron Hamvas, Philip L. Ballard, Roberta A. Ballard, Roberta L. Keller & 31 others Amir M. Khan, Leslie Lusk, Dennis W. Nielson, Elizabeth E. Rogers, David J. Durand, Jeffrey D. Merrill, Eric C. Eichenwald, Candice Fike, Tina Hartert, Paul Moore, Judy Aschner, Scott Guthrie, Nathalie Maitre, Marshall Summar, Carl D'Angio, Vasanth Kumar, Tom Mariani, Gloria Pryhuber, Anne Marie Reynolds, Kristin Scheible, Timothy Stevens, Clement Ren, Rita M. Ryan, C. Michael Cotten, Kim Fisher, Jack Sharp, Judith A. Voynow, Stephanie Davis, Brenda Poindexter, Jonas Ellenberg, Rui Feng

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Abstract

Objective: To determine if daily respiratory status improved more in extremely low gestational age (GA) premature infants after diuretic exposure compared with those not exposed in modern neonatal intensive care units. Study design: The Prematurity and Respiratory Outcomes Program (PROP) was a multicenter observational cohort study of 835 extremely premature infants, GAs of 230/7-286/7 weeks, enrolled in the first week of life from 13 US tertiary neonatal intensive care units. We analyzed the PROP study daily medication and respiratory support records of infants ≤34 weeks postmenstrual age. We determined whether there was a temporal association between the administration of diuretics and an acute change in respiratory status in premature infants in the neonatal intensive care unit, using an ordered categorical ranking of respiratory status. Results: Infants in the diuretic exposed group of PROP were of lower mean GA and lower mean birth weight (P <.0001). Compared with infants unexposed to diuretics, the probability (adjusted for infant characteristics including GA, birth weight, sex, and respiratory status before receiving diuretics) that the exposed infants were on a higher level of respiratory support was significantly greater (OR, >1) for each day after the initial day of diuretic exposure. Conclusions: Our analysis did not support the ability of diuretics to substantially improve the extremely premature infant's respiratory status. Further study of both safety and efficacy of diuretics in this setting are warranted. Trial Registration: Clinicaltrials.gov: NCT01435187.

LanguageEnglish (US)
JournalJournal of Pediatrics
DOIs
StateAccepted/In press - Jan 1 2018

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Diuretics
Gestational Age
Cohort Studies
Newborn Infant
Neonatal Intensive Care Units
Extremely Premature Infants
Premature Infants
Therapeutics
Birth Weight
Observational Studies
Outcome Assessment (Health Care)
Safety

Keywords

  • diuretic
  • prematurity
  • respiratory distress

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Acute Responses to Diuretic Therapy in Extremely Low Gestational Age Newborns : Results from the Prematurity and Respiratory Outcomes Program Cohort Study. / Prematurity and Respiratory Outcomes Program.

In: Journal of Pediatrics, 01.01.2018.

Research output: Contribution to journalArticle

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title = "Acute Responses to Diuretic Therapy in Extremely Low Gestational Age Newborns: Results from the Prematurity and Respiratory Outcomes Program Cohort Study",
abstract = "Objective: To determine if daily respiratory status improved more in extremely low gestational age (GA) premature infants after diuretic exposure compared with those not exposed in modern neonatal intensive care units. Study design: The Prematurity and Respiratory Outcomes Program (PROP) was a multicenter observational cohort study of 835 extremely premature infants, GAs of 230/7-286/7 weeks, enrolled in the first week of life from 13 US tertiary neonatal intensive care units. We analyzed the PROP study daily medication and respiratory support records of infants ≤34 weeks postmenstrual age. We determined whether there was a temporal association between the administration of diuretics and an acute change in respiratory status in premature infants in the neonatal intensive care unit, using an ordered categorical ranking of respiratory status. Results: Infants in the diuretic exposed group of PROP were of lower mean GA and lower mean birth weight (P <.0001). Compared with infants unexposed to diuretics, the probability (adjusted for infant characteristics including GA, birth weight, sex, and respiratory status before receiving diuretics) that the exposed infants were on a higher level of respiratory support was significantly greater (OR, >1) for each day after the initial day of diuretic exposure. Conclusions: Our analysis did not support the ability of diuretics to substantially improve the extremely premature infant's respiratory status. Further study of both safety and efficacy of diuretics in this setting are warranted. Trial Registration: Clinicaltrials.gov: NCT01435187.",
keywords = "diuretic, prematurity, respiratory distress",
author = "{Prematurity and Respiratory Outcomes Program} and Blaisdell, {Carol J.} and James Troendle and Anne Zajicek and Claire Chougnet and Greenberg, {James M.} and William Hardie and Jobe, {Alan H.} and Karen McDowell and Thomas Ferkol and Holland, {Mark R.} and James Kemp and Levy, {Philip T.} and Phillip Tarr and Singh, {Gautam K.} and Barbara Warner and Aaron Hamvas and Ballard, {Philip L.} and Ballard, {Roberta A.} and Keller, {Roberta L.} and Khan, {Amir M.} and Leslie Lusk and Nielson, {Dennis W.} and Rogers, {Elizabeth E.} and Durand, {David J.} and Merrill, {Jeffrey D.} and Eichenwald, {Eric C.} and Candice Fike and Tina Hartert and Paul Moore and Judy Aschner and Scott Guthrie and Nathalie Maitre and Marshall Summar and Carl D'Angio and Vasanth Kumar and Tom Mariani and Gloria Pryhuber and Reynolds, {Anne Marie} and Kristin Scheible and Timothy Stevens and Clement Ren and Ryan, {Rita M.} and Cotten, {C. Michael} and Kim Fisher and Jack Sharp and Voynow, {Judith A.} and Stephanie Davis and Brenda Poindexter and Jonas Ellenberg and Rui Feng",
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AU - Prematurity and Respiratory Outcomes Program

AU - Blaisdell, Carol J.

AU - Troendle, James

AU - Zajicek, Anne

AU - Chougnet, Claire

AU - Greenberg, James M.

AU - Hardie, William

AU - Jobe, Alan H.

AU - McDowell, Karen

AU - Ferkol, Thomas

AU - Holland, Mark R.

AU - Kemp, James

AU - Levy, Philip T.

AU - Tarr, Phillip

AU - Singh, Gautam K.

AU - Warner, Barbara

AU - Hamvas, Aaron

AU - Ballard, Philip L.

AU - Ballard, Roberta A.

AU - Keller, Roberta L.

AU - Khan, Amir M.

AU - Lusk, Leslie

AU - Nielson, Dennis W.

AU - Rogers, Elizabeth E.

AU - Durand, David J.

AU - Merrill, Jeffrey D.

AU - Eichenwald, Eric C.

AU - Fike, Candice

AU - Hartert, Tina

AU - Moore, Paul

AU - Aschner, Judy

AU - Guthrie, Scott

AU - Maitre, Nathalie

AU - Summar, Marshall

AU - D'Angio, Carl

AU - Kumar, Vasanth

AU - Mariani, Tom

AU - Pryhuber, Gloria

AU - Reynolds, Anne Marie

AU - Scheible, Kristin

AU - Stevens, Timothy

AU - Ren, Clement

AU - Ryan, Rita M.

AU - Cotten, C. Michael

AU - Fisher, Kim

AU - Sharp, Jack

AU - Voynow, Judith A.

AU - Davis, Stephanie

AU - Poindexter, Brenda

AU - Ellenberg, Jonas

AU - Feng, Rui

PY - 2018/1/1

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N2 - Objective: To determine if daily respiratory status improved more in extremely low gestational age (GA) premature infants after diuretic exposure compared with those not exposed in modern neonatal intensive care units. Study design: The Prematurity and Respiratory Outcomes Program (PROP) was a multicenter observational cohort study of 835 extremely premature infants, GAs of 230/7-286/7 weeks, enrolled in the first week of life from 13 US tertiary neonatal intensive care units. We analyzed the PROP study daily medication and respiratory support records of infants ≤34 weeks postmenstrual age. We determined whether there was a temporal association between the administration of diuretics and an acute change in respiratory status in premature infants in the neonatal intensive care unit, using an ordered categorical ranking of respiratory status. Results: Infants in the diuretic exposed group of PROP were of lower mean GA and lower mean birth weight (P <.0001). Compared with infants unexposed to diuretics, the probability (adjusted for infant characteristics including GA, birth weight, sex, and respiratory status before receiving diuretics) that the exposed infants were on a higher level of respiratory support was significantly greater (OR, >1) for each day after the initial day of diuretic exposure. Conclusions: Our analysis did not support the ability of diuretics to substantially improve the extremely premature infant's respiratory status. Further study of both safety and efficacy of diuretics in this setting are warranted. Trial Registration: Clinicaltrials.gov: NCT01435187.

AB - Objective: To determine if daily respiratory status improved more in extremely low gestational age (GA) premature infants after diuretic exposure compared with those not exposed in modern neonatal intensive care units. Study design: The Prematurity and Respiratory Outcomes Program (PROP) was a multicenter observational cohort study of 835 extremely premature infants, GAs of 230/7-286/7 weeks, enrolled in the first week of life from 13 US tertiary neonatal intensive care units. We analyzed the PROP study daily medication and respiratory support records of infants ≤34 weeks postmenstrual age. We determined whether there was a temporal association between the administration of diuretics and an acute change in respiratory status in premature infants in the neonatal intensive care unit, using an ordered categorical ranking of respiratory status. Results: Infants in the diuretic exposed group of PROP were of lower mean GA and lower mean birth weight (P <.0001). Compared with infants unexposed to diuretics, the probability (adjusted for infant characteristics including GA, birth weight, sex, and respiratory status before receiving diuretics) that the exposed infants were on a higher level of respiratory support was significantly greater (OR, >1) for each day after the initial day of diuretic exposure. Conclusions: Our analysis did not support the ability of diuretics to substantially improve the extremely premature infant's respiratory status. Further study of both safety and efficacy of diuretics in this setting are warranted. Trial Registration: Clinicaltrials.gov: NCT01435187.

KW - diuretic

KW - prematurity

KW - respiratory distress

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