Use of diuretics in the neonatal period. The use of diuretics is extremely frequent in sick neonates, the more so in very premature newborn infants. This review presents the basic aspects of body fluid homeostasis in the neonate, discusses the development of kidney function, and describes the mechanisms involved in electrolyte and water reabsorption along the nephron. Diuretics are then classified according to the site of their action on sodium reabsorption. The use of diuretics in sodium-retaining states, in oliguric states, in electrolyte disorders, and in arterial hypertension, as well as in a few specific disorders, is presented.
Furosemide use in Italian neonatal intensive care units: a national survey. Furosemide is approved in full term neonates to treat edema associated with congestive heart failure, cirrhosis and renal diseases. It is often administered off-label in premature neonates, to treat respiratory conditions and at doses greater-than-recommended. The authors conducted a national survey (2017) in Italy, using a 14-item multiple-choice online questionnaire sent to all NICU directors. The intravenous and oral routes were chosen primarily; the intravenous administration in single doses predominated over continuous infusion. Its main therapeutic indications were congestive heart failure/overload (94.7%) and oligo-anuria (87.7%). However, furosemide was also frequently used for broncopulmonary dysplasia (50.9%) and respiratory distress syndrome and/or transient tachypnea of the newborn (24.6%). In 28/57 NICUs, furosemide was administered at doses higher-than-recommended. The authors conclude that furosemide is commonly prescribed to term and preterm newborns in Italian NICUs for labeled and unlabeled indications. Doses greater-than-recommended are frequent. Such use is not necessarily inappropriate, but more research is required to assess the efficacy and safety.
Efficacy and Safety of Phenobarbitone as First-Line Treatment for Neonatal Seizure: A Systematic Review and Meta-Analysis. Phenobarbitone is used as a first-line drug for neonatal seizures. The authors aimed to determine the efficacy and safety of the use of phenobarbitone as a first-line agent compared to other anti-epileptic drugs (AEDs) in neonates. They screened 443 records and identified nine eligible studies (719 participants). Five RCTs comparing phenobarbitone with levetiracetam did not find any difference in seizure control with the first dose or adverse effects. Two trials comparing phenobarbitone and phenytoin also did not find any difference in seizure control with the first dose and other outcomes. Only one RCT compared phenobarbitone and lorazepam and found lorazepam to be more efficacious in seizure control with the first dose (RR 0.71; 95% CI 0.53-0.94). Three trials compared neurodevelopmental outcomes, in which levetiracetam was better in two, whereas one did not find any difference. They concluded that phenobarbitone is at least as efficacious and safe as other drugs like phenytoin and levetiracetam. The data over the long-term neurodevelopmental outcome are lacking. The existing evidence is insufficient to recommend other drugs over phenobarbitone.