Kasniya Gangajal, Weinberger Barry, Cerise Jane, Pulju Margaret, Boyar Vitaliya, Frunza Florin, Kurepa Dalibor
Division of Neonatal-Perinatal Medicine, Cohen Children's Medical Center, Northwell Health and Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York, USA.
Feinstein Institutes for Medical Research, Manhasset, New York, USA.
Pediatr Pulmonol. 2022 Dec;57(12):3145-3150. doi: 10.1002/ppul.26150. Epub 2022 Oct 11.
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.
Premature infants requiring noninvasive 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 0-5 was calculated based on the total number of B-lines in six scanned areas. Respiratory support parameters (FiO , nasal cannula flow, or CPAP) were also recorded.
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, FiO , and respiratory flow support decreased significantly from Days 0 to 6 (p < 0.0001, p = 0.001, and p = 0.01, respectively) in the diuretic group, but not in the control group.
Diuretic use is associated with decreased pulmonary edema and improved oxygenation in infants with BPD during the first week of treatment.
支气管肺发育不良（BPD）的特征是肺损伤，伴有不同程度的肺泡化破坏、血管重塑、炎症细胞增殖和肺水肿。利尿剂常用于改善BPD的症状或病程。我们的主要目标是使用肺部超声（LUS）来确定利尿剂是否能减轻BPD婴儿的肺水肿。次要目标是评估利尿剂开始使用后第一周内呼吸支持的变化。
将需要无创呼吸支持且因进展性BPD开始使用利尿剂治疗的早产儿与一组未接受利尿剂治疗的类似婴儿（对照组）进行比较。对于利尿剂组，在开始治疗前以及治疗后第1、3和6天进行LUS检查。对于对照组，在相同时间点进行LUS检查。根据六个扫描区域中B线的总数计算0至5的综合肺水肿严重程度（PES）评分。还记录了呼吸支持参数（FiO₂、鼻导管流量或持续气道正压通气）。
利尿剂组（n = 28）和对照组（n = 23）的婴儿分别在矫正胎龄中位数为34.2（33.3 - 35.9）周和34.0（33.4 - 36.3）周时入组（p = 0.82）。利尿剂组的PES评分、FiO₂和呼吸流量支持从第0天到第6天显著下降（分别为p < 0.0001、p = 0.001和p = 0.01），而对照组则没有。
在治疗的第一周，使用利尿剂与BPD婴儿的肺水肿减轻和氧合改善有关。
