Lung Ultrasound Assessment of Pulmonary Edema in Neonates with Chronic
Lung Disease Before and After Diuretic Therapy
Abstract
Introduction: Bronchopulmonary dysplasia (BPD) is characterized
by lung injury with varying degrees of disrupted alveolarization,
vascular remodeling, inflammatory cell proliferation, and pulmonary
edema. Diuretics are often used to ameliorate the symptoms or
progression of BPD. Our primary objective was to use lung ultrasound
(LUS) to determine if diuretics decrease pulmonary edema in infants with
BPD. The secondary objective was to assess changes in respiratory
support during the first week after initiation of diuretics.
Methods: Premature infants requiring non-invasive respiratory
support and starting diuretic therapy for evolving BPD were compared
with a similar group of infants not receiving diuretics (control). For
the diuretic group, LUS exams were performed before and on days 1, 3 and
6 after initiation of treatment. For the control group, LUS was
performed at equivalent time points. A composite pulmonary edema
severity (PES) score of 0 to 5 was calculated based on the total number
of B-lines in 6 scanned areas. Respiratory support parameters (FiO2,
nasal cannula flow or CPAP) were also recorded. Results:
Infants in the diuretic (n=28) and control (n=23) groups were recruited
at median corrected gestational ages of 34.2 (33.3-35.9) and 34.0
(33.4-36.3) weeks, respectively ( p=0.82). PES scores, FiO2, and
respiratory flow support decreased significantly from day 0 to 6 (
p<.0001, p=0.001, and p=0.01,
respectively) in the diuretic group, but not in the control group.
Conclusion: Diuretic use is associated with decreased pulmonary
edema and improved oxygenation in infants with BPD during the first week
of treatment.