Objectives Diuretics are often given to infants with evolving/established bronchopulmonary dysplasia (BPD) with the hope of improving their pulmonary outcomes. We aimed to determine if diuretic use in preterm infants was associated with improved pulmonary outcomes, but poorer weight gain. Methods An observational study over a 5 year period was undertaken of all infants born at less than 29 weeks of gestation and alive at discharge in all neonatal units in England who received consecutive diuretic use for at least 7 days. Postnatal weight gain and home supplementary oxygen requirement were the outcomes. A literature review of randomised controlled trials (RCTs) and crossover studies was undertaken to determine if diuretic usage was associated with changes in lung mechanics and oxygenation, duration of supplementary oxygen and requirement for home supplementary oxygen. Results In the observational study, 9,457 infants survived to discharge, 44.6% received diuretics for at least 7 days. Diuretic use was associated with an increased probability of supplementary home oxygen of 0.14 and an increase in weight gain of 2.5 g/week. In the review, seven of the 10 studies reported improvements only in short term lung mechanics. There was conflicting evidence regarding whether diuretics resulted in short term improvements in oxygenation. Conclusions Diuretic use was not associated with a reduction in requirement for supplemental oxygen on discharge. The literature review highlighted a lack of RCTs assessing meaningful long-term clinical outcomes. Randomised trials are needed to determine the long-term risk benefit ratio of chronic diuretic use.

中文翻译：

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极度早产儿的产后利尿剂、体重增加和家庭氧气需求

目的 利尿剂通常用于患有发展中/确定的支气管肺发育不良 (BPD) 的婴儿，以期改善他们的肺部预后。我们的目的是确定早产儿使用利尿剂是否与改善肺部预后有关，但与体重增加较差有关。方法 一项为期 5 年的观察性研究对英格兰所有新生儿病房中所有出生时不足 29 周且出院时存活且连续使用利尿剂至少 7 天的婴儿进行。结果是产后体重增加和家庭补充氧气需求。对随机对照试验 (RCT) 和交叉研究进行了文献综述，以确定利尿剂的使用是否与肺力学和氧合作用的变化有关，补充氧气的持续时间和家庭补充氧气的要求。结果 在观察性研究中，9,457 名婴儿存活至出院，其中 44.6% 接受了至少 7 天的利尿剂治疗。利尿剂的使用与家庭补充氧气的可能性增加 0.14 和体重增加 2.5 克/周有关。在审查中，10 项研究中有 7 项报告仅在短期肺力学方面有所改善。关于利尿剂是否导致氧合作用的短期改善，存在相互矛盾的证据。结论 利尿剂的使用与出院时补充氧气需求的减少无关。文献综述强调缺乏评估有意义的长期临床结果的随机对照试验。需要随机试验来确定长期使用利尿剂的长期风险收益比。