Diuretics for respiratory distress syndrome in preterm infants

Background Lung edema may complicate respiratory distress syndrome (RDS) in preterm infants. Objectives The aim of this review was to assess the risks and benefits of diuretic administration in preterm infants with RDS. Search strategy The standard search method of the Cochrane Neonatal Review Group was used. MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library) were searched using the following keywords: < exp respiratory distress syndrome > and < exp diuretics >. These searches were updated in April 2003 and March 2007. In addition, the abstract books of the American Thoracic Society and Society for Pediatric Research were searched. A MEDLINE and CENTRAL search was conducted in March 2007 using the keyword "Respiratory Distress Syndrome" alone, to make sure to find studies medications recently classified as diuretics, such as theophylline. Selection criteria Trials were included in which preterm infants with RDS and less than 5 days of age were randomly allocated to diuretic administration. Of those trials, studies were only included in which at least one of the following outcomes measures was evaluated: mortality, patent ductus arteriosus, hypovolemic shock, intraventricular hemorrhage, renal failure, duration of oxygen supplementation, duration of mechanical ventilation, need for oxygen supplementation at 28 days of life, oxygen supplementation at 36 weeks of postmenstrual age (gestational age+postnatal age), length of stay, number of rehospitalizations during the first year of life, and neurodevelopmental outcome. Data collection and analysis The standard method for the Cochrane Collaboration, which is described in the Cochrane Collaboration Handbook, was used. Two investigators extracted, assessed and coded separately all data for each study. Any disagreement was resolved by discussion. Main results Seven studies met inclusion criteria. Six studies using furosemide were done before the current era of prenatal steroids, surfactant and fluid restriction. Furosemide administration had no long-term benefits. Furosemide-induced transient improvement in pulmonary function did not outweigh an increased risk for patent ductus arteriosus and for hemodynamic instability. In one recent study, theophylline had no long- term benefits. Theophylline significantly decreased the risk of oligoanuria and transiently increased renal function, but did not significantly affect renal function at discharge or other outcomes. Authors' conclusions There are no data to support routine administration of furosemide in preterm infants with RDS. Elective administration of furosemide to any patient with RDS should be carefully weighed against the risk of precipitating hypovolemia or developing a symptomatic patent ductus arteriosus. There are not enough data to support routine administration of low- dose theophylline in preterm infants with RDS.