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Striving to be better: medication overexposure among infants with severe BPD

Journal of Perinatology volume 39, pages 1157–1158 (2019)Cite this article

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We read with great interest the recent article by Barnat et al. [1] entitled “Medication use in infants with severe bronchopulmonary dysplasia (sBPD) admitted to United States children’s hospitals”. This well-designed, retrospective cohort study describes medication use in the management of infants with established, sBPD with specific focus on infants receiving positive pressure support at 36 weeks postmenstrual age (PMA). The data were extracted from the Pediatric Health Information System (PHIS) database between 2007 and 2016, and included infants born <32 weeks’ gestation who were admitted prior to 36 weeks’ PMA and had a hospital admission lasting longer than 1 week. The authors describe (1) overall medication exposures and (2) the most frequently used medications and therapeutic classes with an evaluation of inter-center variability in practice. The results are surprising: the authors report a median of 30 unique cumulative medication exposures per patient with significant variation across centers, with a range of 22–50 unique cumulative medication exposures observed. The study adds to our knowledge of the use of medications across NICU populations [2] by focusing on infants with sBPD after the diagnosis is established at 36 weeks’ PMA, a unique patient population whose management and therapeutic needs are distinct and require further clarification [3].

Many noteworthy “off-label” medication exposures that the authors observe among infants with sBPD lack any compelling evidence of improvements in long-term survival, respiratory morbidity or neurodevelopmental outcomes. Furthermore, several of the common medication exposures have well-described hazardous safety profiles. Furosemide, for example, is known to cause fractures, nephrocalcinosis, electrolyte abnormalities, ototoxicity, and poor growth [4], but has never been shown to improve any long-term outcome in this patient population [5]. Nevertheless, it is the most common medicine exposure (other than those given for health maintenance or fluid, electrolyte and nutrition management) in this study. Indeed 74% of patients were exposed to furosemide at least once, and the cumulative exposure was one of every three hospital days. Moreover, electrolyte abnormalities are so common with the use of diuretics for established sBPD that many providers, including the authors of this study, consider the use of electrolyte supplements to be “routine.” It is, therefore, no surprise that, along with furosemide, potassium chloride and sodium chloride make up the top three medication exposures observed in this study cohort.

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References

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Authors and Affiliations

  1. Comprehensive Center for Bronchopulmonary Dysplasia, Nationwide Children’s Hospital, Department of Pediatrics, The Ohio State University, Columbus, OH, USA

    Matthew J. Kielt, Maria Ferrara & Edward G. Shepherd

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  1. Matthew J. Kielt
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  2. Maria Ferrara
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  3. Edward G. Shepherd
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Correspondence to Edward G. Shepherd.

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Kielt, M.J., Ferrara, M. & Shepherd, E.G. Striving to be better: medication overexposure among infants with severe BPD. J Perinatol 39, 1157–1158 (2019). https://doi.org/10.1038/s41372-019-0459-x

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