Division of Nephrology and Hypertension, Nationwide Children's Hospital, 700 Children's Dr, Columbus, OH, USA.
Nephrology and Urology Research Affinity Group, Nationwide Children's Hospital, Columbus, OH, USA.
Pediatr Nephrol. 2021 Dec;36(12):3981-3991. doi: 10.1007/s00467-021-05132-6. Epub 2021 May 21.
Acute kidney injury (AKI) in preterm infants is associated with prolonged hospitalization and high mortality. Diuretic therapy has been used to enhance urine output in preterm infants with AKI. Treatment with diuretics, prescription patterns, and relationship with length of stay (LOS), mechanical ventilation (MV), and mortality in preterm infants who also had AKI have not been fully evaluated.
This multicenter retrospective study used the Pediatric Hospital Information System database. We included 2121 preterm infants with AKI diagnosis from 46 hospital Neonatal Intensive Care Units (NICUs) born <37 weeks gestational age (GA). Treatment with diuretics, practice patterns across 46 NICUs in the USA, and associated outcomes including LOS, MV, and mortality were evaluated.
Seventy-six percent of infants received at least one dose of diuretics (median treatment 18 days). Diuretic prescription varied significantly across hospitals and ranged from 42 to 96%. Diuretics were used more frequently in infants with younger GA and smaller birth weight. Infants with older GA who received diuretics at or before 28 days postnatally had worse survival even after adjusting for known confounders.
Preterm infants with AKI diagnosis were frequently treated with diuretics. Moreover, infants with younger GA and smaller birth weight were more likely to receive diuretics. Worse survival in infants with older GA who received diuretics could be the result of more underlying severe illness in these infants and not the cause of more severe illness. Prospective studies are needed to best determine patient safety and outcomes with diuretic treatment in preterm infants with AKI. A higher resolution version of the Graphical abstract is available as Supplementary information.
早产儿急性肾损伤（AKI）与住院时间延长和高死亡率相关。利尿剂治疗已被用于增加 AKI 早产儿的尿量。尚未充分评估利尿剂治疗、处方模式以及与早产儿 AKI 患者的住院时间（LOS）、机械通气（MV）和死亡率的关系。
这项多中心回顾性研究使用了儿科医院信息系统数据库。我们纳入了来自 46 家美国新生儿重症监护病房（NICU）的 2121 名胎龄<37 周的 AKI 早产儿。评估了利尿剂治疗、美国 46 家 NICU 的实践模式以及与 LOS、MV 和死亡率相关的结局。
76%的婴儿接受了至少一剂利尿剂（中位数治疗时间为 18 天）。利尿剂处方在各医院之间存在显著差异，范围为 42%至 96%。胎龄较小、出生体重较轻的婴儿更常使用利尿剂。即使在调整了已知混杂因素后，在出生后 28 天内接受利尿剂治疗的胎龄较大的婴儿，其生存率更差。
AKI 诊断的早产儿常接受利尿剂治疗。此外，胎龄较小、出生体重较轻的婴儿更可能接受利尿剂治疗。在接受利尿剂治疗的胎龄较大的婴儿中，生存率更差可能是由于这些婴儿存在更严重的基础疾病，而不是利尿剂治疗导致了更严重的疾病。需要前瞻性研究来最好地确定在 AKI 早产儿中使用利尿剂治疗的患者安全性和结局。更清晰的图形摘要版本可作为补充信息提供。
