Diuretics use in the management of bronchopulmonary dysplasia in preterm infants: A systematic review
Eoin O’Brien, Aisling O. Byrne, J E Dowling, Julia Kiernan, James Carlo Rio Lynch, Lulwa Alomairi, Lauren Coyle, Lorcan Mulkerrin, David Mockler, Geraldine Fitzgerald, Liqa ur Rehman, Gergana Semova, Eman Isweisi, Anne O’Sullivan, Pamela M. J. O’Connor, Kevin Mulligan, Aoife Branagan, Edna Roche, Judith Meehan, Eleanor J. Molloy
Abstract
AIM: Bronchopulmonary dysplasia (BPD), a respiratory complication associated with neonatal prematurity, presents opportunities for pharmacological intervention due to its contributing risk factors. Despite diuretics' controversial usage in BPD treatment and varying institutional practices, this review aims to consolidate evidence from clinical trials regarding diuretic use in BPD. METHODS: We conducted a systematic review following PRISMA guidelines, searching EMBASE, Medline, Web of Science and CINAHL databases (PROSPERO 2022: CRD42022328292). Covidence facilitated screening and data extraction, followed by analysis and formatting in Microsoft Excel. RESULTS: Among 430 screened records, 13 were included for analysis. Three studies assessed spironolactone and chlorothiazide combinations, two studied spironolactone and hydrochlorothiazide, while eight examined furosemide. All studies evaluated drug effects on dynamic pulmonary compliance and pulmonary resistance, serving as comparative measures in our review. CONCLUSION: Diuretics' effectiveness in treating bronchopulmonary dysplasia remains uncertain. The limited number of identified randomised controlled trials (RCTs) hampers high-level evidence-based conclusions when applying the Population, Intervention, Comparison, Outcome (PICO) approach. Conducting large prospective studies of good quality could provide more definitive insights, but the rarity of outcomes and eligible patients poses challenges. Further research, primarily focusing on RCTs assessing diuretics' safety and efficacy in this population, is warranted.