Management of diuretics in infants with bronchopulmonary dysplasia
discharged on home oxygen.
Abstract
Background: Infants with Bronchopulmonary Dysplasia (BPD) are
often prescribed diuretics before the neonatal intensive care unit
(NICU) discharge. It is unknown whether outpatient medication weaning
strategies affect duration of home oxygen therapy. Methods:
This was a secondary cohort analysis of infants born <32 weeks
gestational age with BPD from 2015-2018 discharged from our NICU or
regional NICUs, referred to our pulmonary clinic for home oxygen
management. We compared three groups: those discharged with no
diuretics, diuretics actively weaned (dose decreased) and diuretics
passively weaned (dose not adjusted). Results: Out of 125
infants, 116 were included in the analysis. Forty-five infants were
discharged without diuretics; 52 infants were discharged with diuretics
that were actively weaned; 19 infants were discharged with diuretics
that were passively weaned. Infants who were passively weaned spent the
most time on home oxygen (median 28 weeks, IQR 16-52; p=0.011); there
were no differences in home oxygen duration in infants actively weaned
(median 13 weeks, IQR 10-26) versus not on diuretics (median 22 weeks,
IQR 12-30, p=0.285). Multivariable adjustment for other illness
characteristics associated with duration of home oxygen did not change
this finding. Conclusions: Active weaning of diuretics did not
prolong duration of home oxygen, in the setting of a standardized
clinical guideline for weaning home oxygen in infants with BPD. These
data can serve as baseline information to implement and test
standardized strategies for outpatient medication management.