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      Fluid restriction for treatment of preterm infants with chronic lung disease

      1 , 2 , 3

      Cochrane Neonatal Group

      Cochrane Database of Systematic Reviews

      Wiley

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          Abstract

          Fluid restriction is often recommended as part of the management of infants with early or established bronchopulmonary dysplasia (BPD). To determine whether fluid restriction as part of the therapeutic intervention for early or established BPD improves clinical outcomes. We used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 1) in the Cochrane Library (searched 16 February 2016), MEDLINE via PubMed (1966 to 16 February 2016), Embase (1980 to 16 February 2016), and CINAHL (1982 to 16 February 2016). We also searched clinical trials' databases, conference proceedings, and the reference lists of retrieved articles for randomised controlled trials and quasi‐randomised trials. Prospective randomised clinical trials comparing two distinct fluid administration volumes in preterm infants with early or established BPD. We used the standard methods of Cochrane Neonatal. For the included trial, we extracted data and assessed the risk of bias, and used GRADE methods to assess the quality of the evidence. The outcomes considered in this review are effects on mortality or requirement for oxygen at 36 weeks' postmenstrual age (primary outcome measure), the duration of supplemental oxygen therapy, proportion of infants discharged from hospital on oxygen, duration of assisted ventilation, duration of hospitalisation, weight gain, feeding tolerance, apnoea, necrotizing enterocolitis, renal dysfunction or nephrocalcinosis, lung mechanics, and use of diuretic therapy (secondary outcome measures). One trial was found, including 60 preterm infants at 28 days of age with persistent oxygen requirements. Infants were randomised to either 180 mL/kg/day of standard formula or 145 mL/kg/day of concentrated formula. This single study did not provide data regarding our primary outcome. No effects of the intervention were found on any of our secondary outcomes. The quality of the evidence from this study was graded low. There is no evidence to support the practice of fluid restriction in infants with early or established BPD. Fluid restriction as a treatment for preterm infants developing chronic lung disease Background 
 Babies born prematurely are at risk of developing a form of chronic lung disease which is defined as persistent need for oxygen once the child has reached a corrected gestational age of 36 weeks. As fluid accumulation in the lung is one of the processes involved in the early phases of lung disease in premature babies, low fluid intake might halt the progression of the insult and result in lower rates of chronic lung disease of prematurity. Study characteristics 
 Our search identified only one study comparing two volumes of fluid intake in preterm infants with early signs of chronic lung disease. Unfortunately, this study did not report progression to established chronic lung disease. Hence, no infant could be included in this analysis. Other outcomes, including days that the baby needed extra oxygen, proportion of infants discharged from hospital on oxygen, days of assisted ventilation, duration of hospital stay, weight gain and serious apnoeas were not affected by the volume of fluid received (from the evidence graded as low quality). The evidence is current to February 2016. Key results 
 There is no study comparing low to high fluid intake in a population of preterm babies with early signs of chronic respiratory disease to prevent progression to full blown chronic lung disease or death. Other outcomes were not improved by fluid restriction. Quality of evidence 
 Not applicable.

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          Most cited references 8

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          The new bronchopulmonary dysplasia.

           Alan Jobe (2011)
          Bronchopulmonary dysplasia (BPD) remains the most common severe complication of preterm birth. A number of recent animal models and clinical studies provide new information about pathophysiology and treatment. The epidemiology of BPD continues to demonstrate that birth weight and gestational age are most predictive of BPD. Correlations of BPD with chorioamnionitis are clouded by the complexity of the fetal exposures to inflammation. Excessive oxygen use in preterm infants can increase the risk of BPD but low saturation targets may increase death. Numerous recent trials demonstrate that many preterm infants can be initially stabilized after delivery with continuous positive airway response (CPAP) and then be selectively treated with surfactant for respiratory distress syndrome. The growth of the lungs of the infant with BPD through childhood remains poorly characterized. Recent experiences in neonatology suggest that combining less invasive care strategies that avoid excessive oxygen and ventilation, decrease postnatal infections, and optimize nutrition may decrease the incidence and severity of BPD.
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            Bronchopulmonary dysplasia: possible relationship to pulmonary edema.

            The pathogenesis of bronchopulmonary dysplasia is controversial. Oxygen toxicity, mechanical trauma to the lung secondary to respirator therapy, and congestive heart failure with a left to right shunt through a patent ductus arteriosus have all been implicated. Our data suggest that in addition to these three conditions, all of which are edemagenic, infants with bronchopulmonary dysplasia have a significantly greater mean fluid intake in the first five days of life when compared with infants with respiratory distress syndrome or patent ductus arteriosus alone. We suggest that the addition of a fluid load may potentiate the effects of other factors and increase the risk of bronchopulmonary dysplasia in infants with respiratory distress syndrome who require respiratory support.
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              Controlled trial of furosemide therapy in infants with chronic lung disease.

              To study the effects of furosemide therapy in infants with chronic lung disease (CLD), a double-blind controlled trial was designed. Seventeen infants with evidence of CLD (oxygen requirements greater than 30% at greater than 3 weeks of age and chest radiographic findings consistent with CLD) were studied. Pulmonary function was measured immediately before, and after 48 hours and 7 days of treatment with furosemide (1 mg/kg/12 hr intravenously or 2 mg/kg/12 hr orally) or placebo. Clinical status improved in six of seven infants who received furosemide and in two of 10 infants who received placebo (P less than 0.002). In the furosemide group, ventilator and oxygen requirements decreased (P less than 0.003); minute ventilation, alveolar ventilation, and dynamic compliance increased; and venous admixture decreased (P less than 0.05). There were no significant changes in the placebo group. Our findings suggest that furosemide significantly improves lung function during therapy in infants with CLD and allows earlier weaning from ventilatory support and supplemental oxygen.
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                Author and article information

                Journal
                Cochrane Database of Systematic Reviews
                Wiley
                14651858
                February 08 2017
                Affiliations
                [1 ]CHU Ste-Justine; Department of Pediatrics; 3175 Cote Ste Catherine Montreal QC Canada H3T 1C5
                [2 ]Sainte Justine University Health Center; Department of Neonatology; 3175 Cote Sainte Catherine Montreal QC Canada H3T 1C5
                [3 ]Université de Montréal; Montreal ON Canada
                Article
                10.1002/14651858.CD005389.pub2
                6464249
                28176308
                © 2017
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