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.