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Furosemide for packed red cell transfusion in preterm infants: a randomized controlled trial.

Author(s): Balegar V KK, Kluckow M.

Affiliation(s): 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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