Timothy D Nelin1, Scott Lorch2, Erik A Jensen2,3, Stamatia Alexiou3,4, Kathleen Gibbs2,3, Natalie Napolitano3,5, Heather M Monk6, Susan Furth7, Justine Shults8, Nicolas A Bamat2,3. 1. Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA. nelint@email.chop.edu. 2. Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA. 3. Chronic Lung Disease Program, The Children's Hospital of Philadelphia, Philadelphia, PA, USA. 4. Division of Pulmonary Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA. 5. Respiratory Therapy Department, The Children's Hospital of Philadelphia, Philadelphia, PA, USA. 6. Pharmacy Services, The Children's Hospital of Philadelphia, Philadelphia, PA, USA. 7. Division of Nephrology, The Children's Hospital of Philadelphia, Philadelphia, PA, United States. 8. Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
Abstract
OBJECTIVE: To evaluate the association between chronic diuretic exposures and enteral electrolyte use in infants developing severe bronchopulmonary dysplasia (sBPD). STUDY DESIGN: Retrospective longitudinal cohort study in infants admitted to United States children's hospitals. We identified diuretic exposures and measured enteral NaCl and KCl use during pre-defined exposure risk-interval days. We used mixed-effects logistic regression to model the association between diuretic exposures and electrolyte use. RESULTS: We identified 442,341 subject-days in 3252 infants. All common diuretic classes and class combinations were associated with increased NaCl and KCl use. Thiazide monotherapy was associated with greater electrolyte use than loop monotherapy. The addition of potassium-sparing diuretics was associated with a limited reduction in KCl use compared to thiazide monotherapy. CONCLUSIONS: Chronic diuretic exposures are associated with increased NaCl and KCl use. Presumptions about the relative impact of different diuretic classes on electrolyte derangements may be inaccurate and require further study.
OBJECTIVE: To evaluate the association between chronic diuretic exposures and enteral electrolyte use in infants developing severe bronchopulmonary dysplasia (sBPD). STUDY DESIGN: Retrospective longitudinal cohort study in infants admitted to United States children's hospitals. We identified diuretic exposures and measured enteral NaCl and KCl use during pre-defined exposure risk-interval days. We used mixed-effects logistic regression to model the association between diuretic exposures and electrolyte use. RESULTS: We identified 442,341 subject-days in 3252 infants. All common diuretic classes and class combinations were associated with increased NaCl and KCl use. Thiazide monotherapy was associated with greater electrolyte use than loop monotherapy. The addition of potassium-sparing diuretics was associated with a limited reduction in KCl use compared to thiazide monotherapy. CONCLUSIONS: Chronic diuretic exposures are associated with increased NaCl and KCl use. Presumptions about the relative impact of different diuretic classes on electrolyte derangements may be inaccurate and require further study.
Authors: Steven H Abman; Joseph M Collaco; Edward G Shepherd; Martin Keszler; Milenka Cuevas-Guaman; Stephen E Welty; William E Truog; Sharon A McGrath-Morrow; Paul E Moore; Lawrence M Rhein; Haresh Kirpalani; Huayan Zhang; Linda L Gratny; Susan K Lynch; Jennifer Curtiss; Barbara S Stonestreet; Robin L McKinney; Kevin C Dysart; Jason Gien; Christopher D Baker; Pamela K Donohue; Eric Austin; Candice Fike; Leif D Nelin Journal: J Pediatr Date: 2016-11-28 Impact factor: 4.406
Authors: Barbara J Stoll; Nellie I Hansen; Edward F Bell; Michele C Walsh; Waldemar A Carlo; Seetha Shankaran; Abbot R Laptook; Pablo J Sánchez; Krisa P Van Meurs; Myra Wyckoff; Abhik Das; Ellen C Hale; M Bethany Ball; Nancy S Newman; Kurt Schibler; Brenda B Poindexter; Kathleen A Kennedy; C Michael Cotten; Kristi L Watterberg; Carl T D'Angio; Sara B DeMauro; William E Truog; Uday Devaskar; Rosemary D Higgins Journal: JAMA Date: 2015-09-08 Impact factor: 56.272