Frusemide in respiratory distress syndrome.

Abstract

Archives of Disease in Childhood, 50, 709. Frusemide in respiratory distress syndrome. The effect of frusemide on urinary volume, ary sodium excretion, and urinary calcium excretion in 7 premature infants with severe respiratory distress syndrome (RDS) has been studied. The results are compared with similar measurements on 13 infants of comparable gestational age and birthweight with less severe RDS who did not receive frusemide. The effect of frusemide on Pao2 and Paco2 tensions in 5 infants with RDS was also investigated.Frusemide produced a fourfold increase in urinary volume and a tenfold increase in urinary sodium and urinary calcium excretion compared with the untreated group. It caused no improvement in blood gas tensions. The use of this diuretic for the routine management of RDS cannot be recommended.Severe interstitial oedema is found on histological examination of the lungs of infants dying from the respiratory distress syndrome (RDS) during the first few hours of life (Gandy, Jacobson, and Gairdner, 1970). In pulmonary oedema developing in other clinical situations in the neonatal period, frusemide has been shown to be an effective diuretic (Richardson, 1971). It was therefore decided to study the effect of frusemide on blood gas tensions and fluid and electrolyte balance during the first 24 hours oflife in infants suffering from severe RDS.Material and methods Two groups of infants were studied. 7 infants received frusemide and 13 infants received no diuretic and constituted an untreated group. Patients were randomly allocated to the 2 groups but were not matched for the severity of RDS. All infants had RDS according to classical criteria (Davies et al., 1972). The infants in the treated group had more severe RDS than those in the untreated group (Tables I and II). The management of the infants was that in current use in the unit, which includes umbilical arterial and venous catheterization (Davies et al., 1972). Present addresses: *Department of Paediatrics, Guy's Hospital, London. tNuffleld Institute for Medical Research, Oxford. tAddenbrooke's Hospital, Cambridge. constant inspired oxygen concentration. Blood gases were measured (using the IL 313 Blood Gas Analyser) immediately before, 20 minutes after, and 60 minutes after each dose of diuretic. They were also routinely measured 4-hourly during the first 24 hours of life.The fluid, calcium, and sodium intake of all infants was measured during the first 24 hours of life. All urine passed during this period was collected, the volume noted, and the calcium and sodium concentrations measured. Measurements were also made of plasma sodium (by flame photometry), calcium (by titrimetric method using EDTA), osmolality (Advanced osmometer), albumin (Bromocresol green colorimetry), and colloid osmotic pressure (using a pressure transducer osmometer as described by Baum et al. (1971) on cord blood and blood samples taken at 24 hours of age.The data from the 7 infants who received frusemide were compared with data derived from the 13 infants in the untre...

The Effects of Bumetanide and Furosemide on Lung Liquid Secretion in Fetal Sheep

“…This secretion might be reduced directly by furosemide, but only at very high doses. This is in agreement with several recent studies (17)(18)(19) showing the ineffectiveness of furosemide in treating infant respiratory distress syndrome. However, the work given here suggests that bumetanide might be more effective.…”

Renal response to frusemide in preterm infants with respiratory distress syndrome during the first three postnatal days.

“…During a period of two years, renal function tests, serum and urinary electrolytes, and osmolality were assessed in 85 infants who met the following study criteria: (1) birthweight 2000 g, or less; (2) presence of respiratory distress syndrome; and (3) normal cardiovascular status shown by normal blood pressure and capillary filling. The infants were randomly assigned to two groups: the first consisted of 42 infants who received three intravenous doses of frusemide (1 mg/kg) at approximately 24 hour intervals; the second consisted of 43 infants who were treated similarly but were not given frusemide.…”

“…The data were analysed and the statistical significances between the groups are shown in Table 4. The results can be summarised as follows: (1) within the study group, infants with an Apgar score greater than 3 had better diuretic response than those whose scores was 3 or less; (2) in the control group, infants with an Apgar score of greater than 3 had higher urine output and a higher glomerular filtration rate than infants whose score was 3 or less at 48 to 72 hours after entry into study; (3) for those infants ns=not significant (individual data available upon request). All the significance values indicated show that study group infants or those with Apgar scores greater than 3, or both, had a greater urine output, fractional sodium excretion, and glomerular filtration rate than control infants or those with an Apgar score of 3 or less.…”

Use and misuse of albumin infusions in neonatal care

“…Those data suggest that administration of albumin to``hypoalbuminaemic'', sick preterm infants is unlikely to inuence their respiratory status, which was predictable from the failure of other diuresis promoting agents in such circumstances to lessen ventilatory requirements. For example, frusemide administration, which promoted diuresis and weight loss, has not been shown to alter the course of RDS [21,30,35].…”