Survey on the investigations and use of diuretics in CLD

1. Survey on the investigations and use of diuretics in CLD ShaziaIram & Sadiya Gumi VishnaRasiah Quad Network Research Study Day

2. Chronic Lung Disease (CLD) • Major morbidity in the extremely preterm • At some stage patients with CLD would have received diuretics • No evidence for routine use of diuretics

3. Mechanism Of Action

4. Current Evidence • Brion LP, Primhak RA, Yong W. Aerosolized diuretics for preterm infants with (or developing) chronic lung disease. Cochrane Database Syst Rev 2006; • single dose may transiently improve lung mechanics, although not enough information is available to assess the effect of chronic administration on oxygenation and pulmonary mechanics • Stewart A, Brion LP. Intravenous or enteral loop diuretics for preterm infants with (or developing) chronic lung disease. Cochrane Database Syst Rev 2011; • In patients older than 3 weeks, pulmonary mechanics and oxygenation improved after a week of furosemide. However, data on relevant long-term clinical outcomes are lacking, and routine use of loop diuretics in this population cannot be recommended

5. Current Evidence • Diuretics acting on the distal renal tubule for preterm infants with (or developing) chronic lung disease. Cochrane Database Syst Rev 2011; • Paucity of randomized controlled trials • Most studies failed to assess important clinical outcomes • no strong evidence of benefit from the routine use of distal diuretics in preterm infants with chronic lung diseased

6. Current evidence • The investigators further stated that studies are needed to assess • whether thiazide administration improves • Mortality • duration of O2 dependency, • duration of ventilator-dependency • length of hospital stay • long-term outcome • Risks and benefits of adding spironolactone to thiazides and metolazoneto furosemide

7. Aim • To survey which investigations are undertaken in babies with CLD • The use of diuretics in babies with CLD in nasal prong oxygen at 36 weeks corrected gestational age (CGA) within the Quad Network

8. Method • A telephone survey was carried out among the neonatal units within Quad Network. Medical staffs were questioned if their units had a written protocols for investigating babies with CLD in nasal prong oxygen at 36 weeks CGA, whether they used diuretics in the management of such babies and if any other medications were used.

9. 24 units contacted

10. Staff contacted

11. Written Protocol For CLD

12. Diuretics use in patients in Nasal Prong Oxygen at 36 weeks CGA

13. Investigations

14. Summary • 42% of the units had written protocols • The investigations undertaken • Chest X-ray in 37%, • ECG in 29% • Echocardiogram in 29%. • ~80% of units used diuretics in babies with CLD in nasal prong oxygen at 36 weeks CGA.

15. Conclusion • We found that less than 50% of units had written guidelines for the management of babies with CLD. • The investigations undertaken varied widely. • 80% of units use diuretics

16. Conclusion • Despite the current lack of evidence about the efficacy of diuretics in CLD, most Neonatologists would consider using them. • Clear guidelines on the use of diuretics in CLD need to be developed.