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The association between diuretic class exposures and enteral electrolyte use in infants developing grade 2 or 3 bronchopulmonary dysplasia in United States children’s hospitals

Journal of Perinatology volume 41, pages 779–785 (2021)Cite this article

Subjects

Abstract

Objective

To evaluate the association between chronic diuretic exposures and enteral electrolyte use in infants developing severe bronchopulmonary dysplasia (sBPD).

Study design

Retrospective longitudinal cohort study in infants admitted to United States children’s hospitals. We identified diuretic exposures and measured enteral NaCl and KCl use during pre-defined exposure risk-interval days. We used mixed-effects logistic regression to model the association between diuretic exposures and electrolyte use.

Results

We identified 442,341 subject-days in 3252 infants. All common diuretic classes and class combinations were associated with increased NaCl and KCl use. Thiazide monotherapy was associated with greater electrolyte use than loop monotherapy. The addition of potassium-sparing diuretics was associated with a limited reduction in KCl use compared to thiazide monotherapy.

Conclusions

Chronic diuretic exposures are associated with increased NaCl and KCl use. Presumptions about the relative impact of different diuretic classes on electrolyte derangements may be inaccurate and require further study.

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Authors and Affiliations

  1. Division of Neonatology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Timothy D. Nelin, Scott Lorch, Erik A. Jensen, Kathleen Gibbs & Nicolas A. Bamat

  2. Chronic Lung Disease Program, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Erik A. Jensen, Stamatia Alexiou, Kathleen Gibbs, Natalie Napolitano & Nicolas A. Bamat

  3. Division of Pulmonary Medicine, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Stamatia Alexiou

  4. Respiratory Therapy Department, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Natalie Napolitano

  5. Pharmacy Services, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Heather M. Monk

  6. Division of Nephrology, The Children’s Hospital of Philadelphia, Philadelphia, PA, United States

    Susan Furth

  7. Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA

    Justine Shults

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  1. Timothy D. Nelin
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Correspondence to Timothy D. Nelin.

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Conflict of interest

Mrs. Napolitano has research/consulting relationships with Dräger Medical, Timpel, Smiths Medical, Aerogen, VERO-Biotech, and Philips/Respironics. The remaining authors have no financial interests to disclose.

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Nelin, T.D., Lorch, S., Jensen, E.A. et al. The association between diuretic class exposures and enteral electrolyte use in infants developing grade 2 or 3 bronchopulmonary dysplasia in United States children’s hospitals. J Perinatol 41, 779–785 (2021). https://doi.org/10.1038/s41372-021-00924-y

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