Furosemide in indomethacin-treated infants – systematic review and meta-analysis |
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Authors: | L P Brion Deborah E Campbell |
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Institution: | (1) Albert Einstein College of Medicine and Montefiore Medical Center, Weiler Hospital, 1825 Eastchester Road, Bronx, NY 10461, USA e-mail: brion@aecom.yu.edu Tel.: +1-718-904-4105, Fax: +1-718-904-2659, US |
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Abstract: | This study was designed to assess: (1) whether furosemide modifies the incidence of failure to close a symptomatic patent
ductus arteriosus (PDA) in response to indomethacin in premature infants, (2) whether furosemide decreases renal and hydromineral
side effects of indomethacin, and (3) whether the effects of furosemide on renal function depend on initial extracellular
volume assessed by blood urea nitrogen (BUN)/creatinine ratio]. We did a systematic review and meta-analysis of all published
controlled trials assessing either ductal closure or renal function after randomized allocation to treatment with indomethacin
and furosemide versus indomethacin alone. All of the three studies meeting entry criteria were small and had methodological
limitations. The number of patients was too small to rule out a 10% risk increase in failure of ductal closure. After the
first dose of indomethacin, patients receiving furosemide had higher urine output, fractional excretion of sodium, and osmolar
clearance than controls. Among patients with initial BUN/creatinine ratio <20, those on furosemide had a higher glomerular
filtration rate (GFR) than controls. Among patients with initial BUN/creatinine of 20–30, those on furosemide had a lower
GFR than controls. Thus, dehydration appears to be a contraindication for furosemide administration in premature infants treated
with indomethacin for symptomatic PDA. The risk-benefit ratio of administering furosemide in well-hydrated patients treated
with indomethacin for symptomatic PDA could only be assessed by a large randomized clinical trial.
Received: 1 July 1998 / Revised: 22 September 1998 / Accepted: 23 September 1998 |
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Keywords: | Furosemide Indomethacin Infant newborn Meta-analysis Patent ductus arteriosus Renal function |
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