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The role of furosemide and fluid management for a hemodynamically significant patent ductus arteriosus in premature infants

Journal of Perinatology volume 42, pages 1703–1707 (2022)Cite this article

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Abstract

A patent ductus arteriosus (PDA) in infants born premature can present significant management challenges for neonatal providers. Quantifying a hemodynamically significant PDA (hsPDA) represents the first hurdle, however, identifying the best evidence-based approach amongst conservative, pharmacologic, and/or interventional management options has proven to be even more complicated. Within the conservative arm, furosemide to reduce pulmonary edema and improve lung function has spawned several discussions given the concerns for its upregulation of prostaglandin E2 in the kidneys and conflicting outcomes data. There remains no consensus regarding furosemide use in hsPDAs. In this perspective article, we summarize the approach to defining a hsPDA, review the current practice of furosemide use in the management of hsPDA, and suggest an approach to fluid management and diuresis to address the question: is the routine use of furosemide in hsPDA merited in current practice?

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Fig. 1: Effect of furosemide on prostaglandin secretion in the kidneys.

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Author information

Authors and Affiliations

  1. Department of Pediatrics, Harvard Medical School, Boston, MA, USA

    Sarah Dudley & Philip T. Levy

  2. Division of Neonatology and Pediatric Cardiology, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Shawn Sen

  3. Department of Pharmacy, Boston Children’s Hospital, Boston, MA, USA

    Alison Hanson

  4. Department of Neonatology, The Rotunda Hospital, Dublin, Ireland

    Afif El Khuffash

  5. The Royal College of Surgeons in Ireland, Dublin, Ireland

    Afif El Khuffash

  6. Division of Newborn Medicine, Boston Children’s Hospital, Boston, MA, USA

    Philip T. Levy

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  1. Sarah Dudley
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  2. Shawn Sen
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  4. Afif El Khuffash
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  5. Philip T. Levy
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Contributions

SD, SS, AEK, and PL conceptualized the study, shared equal writing responsibilities, edited, and approved the submission.

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Correspondence to Philip T. Levy.

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Dudley, S., Sen, S., Hanson, A. et al. The role of furosemide and fluid management for a hemodynamically significant patent ductus arteriosus in premature infants. J Perinatol 42, 1703–1707 (2022). https://doi.org/10.1038/s41372-022-01450-1

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  • DOI: https://doi.org/10.1038/s41372-022-01450-1

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