Introduction
Infants with bronchopulmonary dysplasia (BPD) are often discharged with
home oxygen therapy.1 Along with home oxygen therapy,
infants are often discharged with diuretic medications. Evidence to
support the use of diuretic therapy in BPD is controversial, with many
questioning the need for this treatment.2-4 After NICU
discharge, data show that diuretic usage decrease over the first year of
life. 4,5 The American Thoracic Society recently
published recommendations for outpatient respiratory management which
suggest against the routine use of diuretics, and recommend
discontinuing them in the outpatient setting.6However, for infants on home oxygen therapy, it remains unclear how and
when to discontinue diuretics, balancing the recommendations to wean
medication against a potential logistic preference to wean from home
oxygen first.
Our outpatient BPD clinic uses a structured guideline to wean from home
oxygen using recorded home oximetry and monthly clinic
visits.7 Along with home oxygen weaning guidelines, we
recently introduced guidelines for active weaning of diuretic
medications for all infants who did not otherwise require them for
cardiovascular indications. The objective of this study was to evaluate
whether actively weaning diuretics, instead of an alternative approach
of allowing the infant to passively outgrow their dose, would be
associated with prolonged weaning from oxygen or trigger unexpected
visits. We hypothesized that active weaning of diuretics in premature
infants discharged on home oxygen would not prolong the duration of home
oxygen therapy.