Iacobelli Silvia, Lorrain Simon, Rabe Ezira, Gouyon Béatrice, Gouyon Jean-Bernard, Bonsante Francesco
Néonatologie, Réanimation Néonatale et Pédiatrique, CHU Saint Pierre, Saint Pierre, France.
Centre d'Etudes Périnatales de l'Océan Indien (UR 7388), Université de La Réunion, Saint Pierre, France.
Front Pharmacol. 2024 Mar 13;15:1358761. doi: 10.3389/fphar.2024.1358761. eCollection 2024.
The use of diuretics is extremely common in infants cared for in neonatal wards, despite the lack of proven efficacy for many conditions. The main objective of this study was to assess the rate of diuretics exposure in a multicenter French cohort. The secondary objectives were to describe the evolution of this exposure over time, the indications, the prescription practices, and the exposure rates among centers. An observational study was conducted in 40 Level 3 French neonatal intensive care units using the same computerized order-entry system. Neonates hospitalized between January 2017 to December 2021 with a corrected age between 24 and 44 weeks of gestation at admission were eligible. A total of 86,032 patients were included. The exposure rate was 8.5%, more specifically 29.4% for children born at < 32 weeks of gestation and 3.7% for neonates born at term. There was no significant variation over the study period, but the exposure ranged from 2.4% to 26.5% depending on the center. The main drugs prescribed were furosemide, spironolactone and dopamine with a diuretic purpose. The main indications were "fluid retention," and to a lesser extent "bronchopulmonary dysplasia" and "post-transfusion." For furosemide, the first exposure occurred in mean at 16.5 (±17.8) days of life, mean duration of exposure was 6.2 (±9.5) days, and the cumulative dose was in mean 10.7 (23.9) mg/kg. Diuretic prescription practices vary between centers. The administration of these drugs is often non-evidence based, doses and duration of treatment easily exceed toxic thresholds.
尽管利尿剂对许多病症的疗效尚未得到证实，但在新生儿病房护理的婴儿中，利尿剂的使用极为普遍。本研究的主要目的是评估法国一个多中心队列中利尿剂的暴露率。次要目的是描述这种暴露随时间的变化、适应症、处方习惯以及各中心之间的暴露率。在法国40家三级新生儿重症监护病房进行了一项观察性研究，这些病房使用相同的计算机医嘱录入系统。2017年1月至2021年12月期间住院、入院时矫正年龄在妊娠24至44周之间的新生儿符合条件。总共纳入了86,032名患者。暴露率为8.5%，具体而言，孕周小于32周出生的儿童为29.4%，足月儿为3.7%。在研究期间没有显著变化，但根据中心不同，暴露率在2.4%至26.5%之间。主要开具的药物是呋塞米、螺内酯和用于利尿目的的多巴胺。主要适应症是“液体潴留”，其次是“支气管肺发育不良”和“输血后”。对于呋塞米，首次暴露平均发生在出生后16.5（±17.8）天，平均暴露持续时间为6.2（±9.5）天，累积剂量平均为10.7（23.9）mg/kg。各中心之间的利尿剂处方习惯有所不同。这些药物的使用往往缺乏循证依据，治疗剂量和持续时间很容易超过中毒阈值。
