The pharmacologic effects of furosemide therapy in the low-birth-weight infant

Ross, Barbara S.; Pollak, Arnold; Oh, William

doi:10.1016/s0022-3476(78)80098-5

Cited by 49 publications

(7 citation statements)

References 12 publications

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“…In infants, t 1/2 is 6 to 20-fold longer, Cl is 1.2 to 14-fold smaller and Vd is 1.3 to 6-fold larger than the adult values. This body of knowledge is consistent with the view that the elimination of furosemide is remarkably slower and variable in neonates than in adults and is associated with its prolonged diuretic and saliuretic effects [76,77]. …”

Section: Resultssupporting

confidence: 87%

Clinical Pharmacology of Furosemide in Neonates: A Review

Pacifici

2013

Pharmaceuticals

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Furosemide is the diuretic most used in newborn infants. It blocks the Na+-K+-2Cl− symporter in the thick ascending limb of the loop of Henle increasing urinary excretion of Na+ and Cl−. This article aimed to review the published data on the clinical pharmacology of furosemide in neonates to provide a critical, comprehensive, authoritative and, updated survey on the metabolism, pharmacokinetics, pharmacodynamics and side-effects of furosemide in neonates. The bibliographic search was performed using PubMed and EMBASE databases as search engines; January 2013 was the cutoff point. Furosemide half-life (t1/2) is 6 to 20-fold longer, clearance (Cl) is 1.2 to 14-fold smaller and volume of distribution (Vd) is 1.3 to 6-fold larger than the adult values. t1/2 shortens and Cl increases as the neonatal maturation proceeds. Continuous intravenous infusion of furosemide yields more controlled diuresis than the intermittent intravenous infusion. Furosemide may be administered by inhalation to infants with chronic lung disease to improve pulmonary mechanics. Furosemide stimulates prostaglandin E2 synthesis, a potent dilator of the patent ductus arteriosus, and the administration of furosemide to any preterm infants should be carefully weighed against the risk of precipitation of a symptomatic patent ductus arteriosus. Infants with low birthweight treated with chronic furosemide are at risk for the development of intra-renal calcifications.

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Section: Resultssupporting

confidence: 87%

Clinical Pharmacology of Furosemide in Neonates: A Review

Pacifici

2013

Pharmaceuticals

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“…The response to furosemide is weaker and delayed in very low-birth-weight neo nates and neonates with respiratory distress syndrome (RDS) [49], in whom renal perfu sion is low. In 6 low-birth-weight infants (< 1,500 g) aged 10-57 days, administration of furosemide (1 mg/kg) produced a net loss of 28 ml/kg of water, 3.5 mmol/kg of sodium and 0.3 mmol/kg of potassium, with an in crease in the excretion of free water [33].…”

Section: Drugs Given After Birthmentioning

confidence: 99%

Adverse Effects of Drugs on the Immature Kidney

Guignard

Jb²

1988

Neonatology

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The immature kidney may be adversely affected by a variety of vasoactive or diuretic drugs, either administered to the mother during pregnancy, or to the neonate. Inhibitors of the angiotensin-converting enzyme administered to the hypertensive pregnant woman can severely and sometimes definitely impair renal function in the fetus, leading to postnatal anuria. Pathogenesis involves interference with the renin-angiotensin system and the prostaglandins. Beta-adrenergic agents administered during labor depress glomerular filtration rate transiently. Tolazoline, an alpha-adrenergic blocking agent useful in the treatment of persistent pulmonary hypertension of the neonate induces intense renal vasoconstriction with consequent hypoperfusion. Indomethacin, a prostaglandin synthetase inhibitor used for the pharmacological closure of a patent ductus arteriosus, also increases renal vascular resistance, and decreases urine output. Furosemide, the drug most often used in oliguric neonates, may also adversely affect the newborn infant. Its use has been associated with an increase in the incidence of patent ductus arteriosus, hypercalciuria, nephrocalcinosis and secondary hyperparathyroidism. These observations demonstrate that the proper use of drugs requires that the therapeutic endpoint be clearly defined and the predictable side effects be anticipated.

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“…receive furosemide for prolonged periods of time, previous investigations of furosemide pharmacodynamics have focused on re sponse to initial doses [2][3][4][5], These studies have demonstrated a brisk furosemide-induced diuresis and natriuresis, despite the…”

Section: Introductionmentioning

confidence: 99%

Renal Response to Furosemide in Very Low Birth Weight Infants during Chronic Administration

Mirochnick¹,

Miceli²,

Kramer³

et al. 1990

Dev Pharmacol Ther

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Renal response to furosemide following initial and chronic doses was investigated in premature infants with bronchopulmonary dysplasia. Seven infants (mean birth weight = 890 ± 216 g, mean gestational age at birth = 27.7 ± 2.6 weeks, mean postnatal age at the start of diuretic therapy = 2.7 ± 0.9 weeks) were studied. Twelve-hour urine collections were performed after the initial dose, and following chronic doses after 1 week and 3 weeks of therapy. Volume of each urine sample was measured and concentrations of furosemide, sodium and creatinine determined. Linear dose-response relationships were found between the logarithm of the urinary furosemide excretion rate and diuretic/natriuretic response (urine output and urinary sodium excretion rate). The furosemide excretion rate required to achieve midrange diuretic and natriuretic responses was significantly greater during chronic dosing than following initial doses, indicating a decrease in renal responsiveness to drug with sustained use. Increasing postconceptional age was associated with a decrease in initial responsiveness to furosemide. These data demonstrate that in premature infants renal sensitivity to furosemide decreases with chronic use as well as with increasing postconceptional age at the start of therapy. The decrease in renal sensitivity to drug with chronic use is of much greater magnitude, and appears to represent renal compensation for drug-induced diuresis and natriuresis.

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The pharmacologic effects of furosemide therapy in the low-birth-weight infant

Cited by 49 publications

References 12 publications

Clinical Pharmacology of Furosemide in Neonates: A Review

Clinical Pharmacology of Furosemide in Neonates: A Review

Adverse Effects of Drugs on the Immature Kidney

Renal Response to Furosemide in Very Low Birth Weight Infants during Chronic Administration

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