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Value of furosemide before transfusion in preemies questioned

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – In hemodynamically stable preterm infants, there seems to be minimal clinical benefit to giving a single dose of furosemide right before packed red blood cell transfusion (PRBCT), according to results of a randomized study, available online now in The Journal of Pediatrics.

“Despite its routine use by some clinicians, there is no convincing evidence regarding the benefits of a single dose of furosemide with PRBCT in preterm infants,” Dr. Martin Kluckow and Dr. Kiran Kumar Balegar from Royal North Shore Hospital, Sydney, Australia, note in their paper.

In addition, furosemide is not risk-free, they point out.

They enrolled in their study 51 hemodynamically stable preterm infants (< 37 weeks gestational age at birth) who were older than 7 days at entry. The infants were randomly assigned to a single 1 milligram per kilogram dose of furosemide or normal saline just before “top up” PRBCT (20 mL/kg over 4 hours).

Pretransfusion variables were comparable in the two groups. Forty infants completed the study (21 in the furosemide arm and 19 in the placebo arm).

Furosemide is often administered with PRBCT because of a concern regarding volume overload and pulmonary congestion that may lead to respiratory decline as detected by an increase in the fraction of inspired oxygen (FiO2), the investigators note in their report.

The primary outcome in their study was a change in FiO2 during the 24 hours after PRBCT compared with the 6-hour pretransfusion period. They report that furosemide with PRBCT did prevent a clinically small but statistically significant (P < 0.05) increase in FiO2 (ie., respiratory deterioration).

However, the maximum increase above the pretransfusion FiO2 was just 7%. When translated into absolute values, this corresponds to an increase in the mean pretransfusion FiO2 from 0.27 to a postransfusion value of 0.29. This is “unlikely to be considered important for day-to-day clinical practice,” the investigators conclude.

It’s also noteworthy, they say, that no infant required open-label treatment with furosemide, “suggesting that furosemide is not a necessary part of blood transfusion in this group of infants.”

Furosemide produced a small statistically significant drop in serum sodium, and had no effect on ventilatory, echocardiographic, clinical hemodynamic, or other electrolyte variables by 24 hours after transfusion.

Far from the final word on this subject, Dr. Kluckow and Dr. Balegar say there may be a group of babies who might benefit from the use of furosemide with PRBCT and further study is needed.

For now, they say the the “small clinical benefits of routine use of furosemide at the time of elective transfusion need to be balanced against the potentially adverse effects.”

Furosemide for Packed Red Cell Transfusion in Preterm Infants: A Randomized Controlled Trial
J Pediatri 2011. Published online July 25, 2011.