Furosemide for packed red cell transfusion in preterm infants: a randomized
controlled trial.
Author(s): Balegar V KK(1), Kluckow M.
Affiliation(s): Author information:
(1)Department of Neonatology, Royal North Shore Hospital, Sydney, Australia.
Publication date & source: 2011, J Pediatr. , 159(6):913-8
OBJECTIVE: To assess the effect of furosemide administered with packed red blood
cell transfusion on cardiopulmonary variables of hemodynamically stable,
electively transfused preterm infants beyond the first week of life.
STUDY DESIGN: A randomized, stratified, double-blind, placebo-controlled trial of
intravenous furosemide (1 mg/kg) versus placebo (normal saline) just before
"top-up" packed red blood cell transfusion (20 mL/kg over 4 hours) in a tertiary
neonatal intensive care unit.
RESULTS: The primary outcome was a change in fraction of inspired oxygen (FiO(2))
during the 24 hours posttransfusion compared with the 6-hour pretransfusion
period. Secondary outcomes were functional echocardiographic and
clinical/biochemical variables. Of 51 consecutive preterm infants with mean (±
SD) birth weights of 900 g (± 28); enrollment weights of 1342 g (± 432); birth
gestation of 27 weeks (± 1); and postmenstrual age of 32 weeks (± 4), 40
completed the study. Pretransfusion variables were comparable between the
furosemide (n = 21) and placebo (n = 19) groups. There was a small but
significant increase (P < .05) in posttransfusion FiO(2) in placebo (relative
increase of 7%, equivalent to an absolute increase from 0.27 to 0.29) compared
with the furosemide group. Other variables were similar. No infant received
open-label furosemide.
CONCLUSIONS: Routine furosemide in electively transfused preterm infants confers
minimal clinical benefits. Prevention of a clinically insignificant FiO(2) rise
needs to be balanced against potential adverse effects.
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