Furosemide use in Italian neonatal intensive care units: a national survey
Abstract Background 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. We conducted a nati...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2020-06-01
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| Series: | Italian Journal of Pediatrics |
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| Online Access: | http://link.springer.com/article/10.1186/s13052-020-00851-2 |
| _version_ | 1818176797379919872 |
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| author | Valeria Anna Manfredini Chiara Cerini Antonio Clavenna Andrea Dotta Maria Letizia Caccamo Alex Staffler Luca Massenzi Rossano Massimo Rezzonico on the behalf of study Group of Neonatal Pharmacoterapy of the Italian Society of Neonatology |
| author_facet | Valeria Anna Manfredini Chiara Cerini Antonio Clavenna Andrea Dotta Maria Letizia Caccamo Alex Staffler Luca Massenzi Rossano Massimo Rezzonico on the behalf of study Group of Neonatal Pharmacoterapy of the Italian Society of Neonatology |
| author_sort | Valeria Anna Manfredini |
| collection | DOAJ |
| description | Abstract Background 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. We conducted a national survey on behalf of the Neonatal Pharmacotherapy Study Group of the Italian Society of Neonatology (SIN), to investigate its use in Italian neonatal intensive care units (NICUs), in conformity with current guidelines. Methods Between December 2016 and June 2017, a 14-item multiple-choice online questionnaire was sent to all NICU directors from the SIN directory. Gestational age, route of administration, posology, indications, referenced guidelines, adverse effects monitoring and the presence of Paediatric Cardiology or Cardiosurgery service on site were assessed. A chi-square test was performed 1) to evaluate differences in the distribution of responses between NICUs administering furosemide at doses higher-than-recommended; 2) to compare the proportion of NICUs administering furosemide at high doses in institutions with versus without a Paediatric Cardiology or Cardiosurgery service. Results The response rate was 50% (57/114). 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. In most NICUs the same posology was used in term and preterm neonates. Compared to the total sample, a larger proportion of NICUs administering doses greater-than-recommended referenced current literature for reasons to do so (19.3 and 32.1% respectively). The presence of a Paediatric Cardiology or Cardiosurgery service on site did not correlate with the chosen posology. The majority of NICUs performed acoustic test and renal ultrasound for furosemide exposure greater than 2 weeks. Conclusions In Italian NICUs, furosemide is commonly prescribed to term and preterm newborns for label and unlabeled indications. Doses greater-than-recommended are frequently administered. Such use is not necessarily inappropriate. More research is required to assess the efficacy and safety of unlabeled use. |
| first_indexed | 2024-12-11T20:21:54Z |
| format | Article |
| id | doaj.art-566227a302904ab7b66214b2042e2d5c |
| institution | Directory Open Access Journal |
| issn | 1824-7288 |
| language | English |
| last_indexed | 2024-12-11T20:21:54Z |
| publishDate | 2020-06-01 |
| publisher | BMC |
| record_format | Article |
| series | Italian Journal of Pediatrics |
| spelling | doaj.art-566227a302904ab7b66214b2042e2d5c2022-12-22T00:52:04ZengBMCItalian Journal of Pediatrics1824-72882020-06-014611810.1186/s13052-020-00851-2Furosemide use in Italian neonatal intensive care units: a national surveyValeria Anna Manfredini0Chiara Cerini1Antonio Clavenna2Andrea Dotta3Maria Letizia Caccamo4Alex Staffler5Luca Massenzi6Rossano Massimo Rezzonico7on the behalf of study Group of Neonatal Pharmacoterapy of the Italian Society of NeonatologyNeonatal Intensive Care Unit, ASST RhodenseChildren’s Hospital Los AngelesDepartment of Public Health, Laboratory for Mother and Child Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCSDepartment of Medical and Surgical Neonatology, Neonatal Intensive Care Unit, Bambino Gesù Children Hospital, IRCCSIndipedent researcher, Former director of Neonatal Intensive Care Unit, Sant’Anna HospitalDivision of Neonatology, Central teaching Hospital of BolzanoNeonatology and Neonatal Intensive Care Unit, “San Giovanni Calibita” Fatebenefratelli HospitalIndipendent researcher, Former director of Neonatal Intensive Care Unit, ASST RhodenseAbstract Background 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. We conducted a national survey on behalf of the Neonatal Pharmacotherapy Study Group of the Italian Society of Neonatology (SIN), to investigate its use in Italian neonatal intensive care units (NICUs), in conformity with current guidelines. Methods Between December 2016 and June 2017, a 14-item multiple-choice online questionnaire was sent to all NICU directors from the SIN directory. Gestational age, route of administration, posology, indications, referenced guidelines, adverse effects monitoring and the presence of Paediatric Cardiology or Cardiosurgery service on site were assessed. A chi-square test was performed 1) to evaluate differences in the distribution of responses between NICUs administering furosemide at doses higher-than-recommended; 2) to compare the proportion of NICUs administering furosemide at high doses in institutions with versus without a Paediatric Cardiology or Cardiosurgery service. Results The response rate was 50% (57/114). 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. In most NICUs the same posology was used in term and preterm neonates. Compared to the total sample, a larger proportion of NICUs administering doses greater-than-recommended referenced current literature for reasons to do so (19.3 and 32.1% respectively). The presence of a Paediatric Cardiology or Cardiosurgery service on site did not correlate with the chosen posology. The majority of NICUs performed acoustic test and renal ultrasound for furosemide exposure greater than 2 weeks. Conclusions In Italian NICUs, furosemide is commonly prescribed to term and preterm newborns for label and unlabeled indications. Doses greater-than-recommended are frequently administered. Such use is not necessarily inappropriate. More research is required to assess the efficacy and safety of unlabeled use.http://link.springer.com/article/10.1186/s13052-020-00851-2FurosemideNewbornPosologyOff-label |
| spellingShingle | Valeria Anna Manfredini Chiara Cerini Antonio Clavenna Andrea Dotta Maria Letizia Caccamo Alex Staffler Luca Massenzi Rossano Massimo Rezzonico on the behalf of study Group of Neonatal Pharmacoterapy of the Italian Society of Neonatology Furosemide use in Italian neonatal intensive care units: a national survey Italian Journal of Pediatrics Furosemide Newborn Posology Off-label |
| title | Furosemide use in Italian neonatal intensive care units: a national survey |
| title_full | Furosemide use in Italian neonatal intensive care units: a national survey |
| title_fullStr | Furosemide use in Italian neonatal intensive care units: a national survey |
| title_full_unstemmed | Furosemide use in Italian neonatal intensive care units: a national survey |
| title_short | Furosemide use in Italian neonatal intensive care units: a national survey |
| title_sort | furosemide use in italian neonatal intensive care units a national survey |
| topic | Furosemide Newborn Posology Off-label |
| url | http://link.springer.com/article/10.1186/s13052-020-00851-2 |
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