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Cardiopulmonary physiological effects of diuretic therapy in preterm infants with chronic pulmonary hypertension

Journal of Perinatology volume 43, pages 1288–1294 (2023)Cite this article

Subjects

Abstract

Objective

Using targeted neonatal echocardiography (TNE) to examine cardiopulmonary physiological impact of diuretics in preterm infants with chronic pulmonary hypertension (cPH).

Study design

Retrospective study comparing TNE indices pre- and ≤2 weeks (post) of initiating diuretic therapy in infants born <32 weeks gestational age with cPH.

Results

Twenty-seven neonates with mean gestational age, birthweight and interval between pre-post diuretic TNE of 27.0 ± 2.8 weeks, 859 ± 294 grams, and 7.8 ± 3.0 days respectively were studied. Diuretics was associated with improvement in pulmonary vascular resistance [pulmonary artery acceleration time (PAAT); 34.27(9.76) vs. 40.24(11.10)ms, p = 0.01), right ventricular (RV) ejection time:PAAT ratio [5.92(1.66) vs. 4.83(1.14), p < 0.01)], RV fractional area change [41.6(9.8) vs. 46.4(6.5%), p = 0.03)] and left ventricular myocardial performance index [0.55(0.09) vs. 0.41(0.23), p < 0.01)]. Post-treatment, frequency of bidirectional/right-to-left inter-atrial shunts decreased significantly (24% vs. 4%, p = 0.05).

Conclusion

Primary diuretic treatment in neonates with cPH may result in improvement in PVR, RV and LV function and compliance.

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Data availability

Study data will be available from the corresponding author on request for any planned study proposal, pending approval from institutional research ethics board and data sharing agreement.

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Author information

Authors and Affiliations

  1. Department of Paediatrics, Mount Sinai Hospital, Toronto, ON, Canada

    Faith Zhu, Michelle Baczynski & Amish Jain

  2. Department of Paediatrics, University of Toronto, Toronto, ON, Canada

    Faith Zhu & Amish Jain

  3. Neonatology Department, Hospital Infantil de México Federico Gómez, Mexico City, Mexico

    Daniel Ibarra Rios

  4. Lausanne University Hospital, Lausanne, Switzerland

    Sebastien Joye

  5. Department of Pediatrics, University of Iowa, Iowa City, IA, USA

    Danielle Rios, Regan E Giesinger & Patrick J. McNamara

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  1. Faith Zhu
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Contributions

FZ and AJ conceived, designed and planned the study, contributed to planning data extraction and analysis, interpretation of results, performed the statistical analysis, wrote first and final draft of the publication and approved the final publication. DIR, SJ, MB and DR contributed to data collection and approved the final publication. REG and PJM critically reviewed the study design and the paper and approved the final publication.

Corresponding author

Correspondence to Amish Jain.

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Zhu, F., Ibarra Rios, D., Joye, S. et al. Cardiopulmonary physiological effects of diuretic therapy in preterm infants with chronic pulmonary hypertension. J Perinatol 43, 1288–1294 (2023). https://doi.org/10.1038/s41372-023-01742-0

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