Neonatal-Perinatal Medicine Fellow University of Kentucky College of Medicine Lexington, Kentucky, United States
Background: Despite limited evidence on their utility and well-documented adverse effects with prolonged exposure, diuretics are often used in preterm infants requiring respiratory support. Clinical response is primarily assessed qualitatively and is subject to observer interpretation, causing wide practice variation and potential for extended use in non-responders. Lung ultrasound scores (LUSc) have excellent correlation with oxygenation status in preterm infants. LUSc may provide an objective assessment of pulmonary mechanics and air-fluid ratio during diuretic use. We aim to assess the response to furosemide in preterm infants on respiratory support using serial LUSc. Objective: 1. To objectively measure response to furosemide in preterm infants < 1500g requiring respiratory support using serial measurement of LUSc. 2. To evaluate the relationship between consecutive LUSc and clinical oxygenation parameters in response to furosemide. Design/Methods: Infants born < 32 weeks with birth weight < 1500g requiring respiratory support (invasive mechanical ventilation or non-invasive CPAP) and receiving more than one dose of furosemide to manage evolving or established BPD were eligible for enrollment in this prospective observational study. Infants with known chromosomal defects, congenital malformations (except PDA and PFO), and prior diuretic exposure were excluded. The study protocol was approved by the IRB and informed consent was obtained from parents before enrollment. LUSc were measured on days 0, 1, 3, 5, and 7 following the first dose, using a validated scoring tool as described by De Luca et al. Two independent blinded experts reviewed the sonograms. Change in consecutively measured LUSc within the first week of exposure will be analyzed using repeated measures ANOVA. The correlation between LUSc and clinical oxygenation parameters (fraction of inspired oxygen and mean airway pressure) will be assessed using Spearman’s correlation coefficient. We expect to complete patient enrollment by March 1, 2024, with final reporting of results to be completed by March 31, 2024.
