OBJECTIVES Postoperative fluid overload is ubiquitous in neonates and infants following operative intervention for congenital heart defects; ineffective diuresis is associated with poor outcomes. Diuresis with furosemide is widely used, yet there is often resistance at higher doses. In theory, furosemide resistance may be overcome with chlorothiazide; however, its efficacy is unclear, especially in lower doses and in this population. We hypothesized the addition of lower-dose, intravenous chlorothiazide following surgery in patients on high-dose furosemide would induce meaningful diuresis with minimal side effects. METHODS This was a retrospective, cohort study. Postoperative infants younger than 6 months, receiving high-dose furosemide, and given lower-dose chlorothiazide (1–2 mg/kg every 6–12 hours) were identified. Diuretic doses, urine output, fluid balance, vasoactive-inotropic scores, total fluid intake, and electrolyte levels were recorded. RESULTS There were 73 patients included. The addition of lower-dose chlorothiazide was associated with a significant increase in urine output (3.8 ± 0.18 vs 5.6 ± 0.27 mL/kg/hr, p < 0.001), more negative fluid balance (16.1 ± 4.2 vs −25.0 ± 6.3 mL/kg/day, p < 0.001), and marginal changes in electrolytes. Multivariate analysis was performed, demonstrating that increased urine output and more negative fluid balance were independently associated with addition of chlorothiazide. Subgroup analysis of 21 patients without a change in furosemide dose demonstrated the addition of chlorothiazide significantly increased urine output (p = 0.03) and reduced fluid balance (p < 0.01), further validating the adjunct effects of chlorothiazide. CONCLUSION Lower-dose, intravenous chlorothiazide is an effective adjunct treatment in postoperative neonates and infants younger than 6 months following cardiothoracic surgery.
To estimate the association between lung hyperin ation and the time to successful transition to outpatient ventilators in infants with sBPD and chronic respiratory failure.
Design/Methods:Infants with sBPD < 32 weeks' gestation who received tracheostomies were identi ed. Hyperin ation was the main exposure. Time from tracheostomy to successful transition to the outpatient device was the main outcome. Kaplan-Meier and multivariable Cox proportional hazards were used to estimate the relationships between hyperin ation and the main outcome.
ResultsSixty-two infants were included; 26 (42%) were hyperin ated. Eleven died before transition, and 51 successfully transitioned. Hyperin ation was associated with both mortality (31% vs 8.3%, p = 0.02) and an increased duration (72 vs. 56 days) to successful transition (hazard ratio (HR) = 0.38, 95% CI: 0.19, 0.76, p = 0.006). Growth velocity was similar after tracheostomy placement.
ConclusionsIn infants with chronic respiratory failure and sBPD < 32 weeks' gestation, hyperin ation is related to mortality and inpatient morbidities.
A case of alveolar microlithiasis which developed spontaneous pneumothorax due to progression of emphysematous bullae during 34 years after established diagnosis.
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