Bronchopulmonary Dysplasia
- Dec 6, 2017
- 1 min read
Treatment : 1. Diuretics a. Thiazide diuretics (e.g., hydrochlorothiazide), potassium-sparing diuretics (e.g., spironolactone), and loop diuretics (e.g., furosemide) are commonly used in clinical practice to decrease pulmonary edema in patients with BPD. b. Electrolyte derangements are common and can lead to complications such as nephrocalcinosis and osteopenia secondary to increased urinary calcium loss. i. Thiazides may have calciuric effects similar to loop diuretics in preterm neonates. ii. Hypochloremia may be associated with a poorer outcome in infants with BPD. iii. Various alterations to the diuretic regimen (e.g., administration by inhalation, every-otherday dosing) have been studied in an effort to minimize adverse effects. Chronic use of diuretics should be discouraged because of the very limited evidence with respect to meaningful benefits, together with the potential for significant adverse effects.
2. Bronchodilators a. β-Agonists have been shown to improve lung compliance and decrease pulmonary resistance. b. They may be beneficial in the management of acute exacerbations of BPD to improve airway hyperactivity. c. Most reports of bronchodilator use in BPD are single-dose studies or short-term evaluations; longterm effects have not been well studied, and there is no evidence of reduced need for ventilator support or mortality.
3. Corticosteroids
a. Systemic corticosteroids – Adverse effects outweigh potential benefits.b. Inhaled corticosteroidsi. Inhaled corticosteroids have the theoretical advantage of decreased systemic adverse effectscompared with systemic corticosteroids; however, trials have not confirmed this.ii. There is no evidence to support long-term clinical benefits, so routine use is not recommended.
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