Bumetanide Use in the Management of Oliguric Preterm Infants with Acute Kidney Injury–A Single Center Experience

Background: Oliguric preterm infants with Acute Kidney Injury (AKI) have significantly higher mortality compared with infants with non-oliguric AKI. The role of loop diuretics in the management of oliguric preterm infants with AKI has not been investigated. We report our center’s experience with bumetanide infusion in extremely low birth weight infants with oliguric AKI. Methods: We performed a retrospective chart review of oliguric preterm infants with AKI treated with bumetanide infusion between July 2009 and August 2011. Results: Acute renal failure and/or AKI with oliguria was diagnosed in 31 (27.6%) very low birth weight infants. In nearly two-thirds oliguria responded to crystalloid and/or intravenous furosemide. 11 patients who remained oliguric were treated with bumetanide. Urinary output was established and maintained in all patients within 2 to 20 hours of starting bumetanide infusion, although their serum creatinine levels took 3 to 17 days to decrease below 1 mg/dl. Variable rates of bumetanide infusion were administered for an average of 7.7 days (1 to 17 days). Five infants survived and had normal renal function at discharge. The two non-survivors died of unrelated causes six days and two months after having recovered from oliguria. Conclusion: In the absence of renal replacement therapy, bumetanide infusion may serve as an important adjuvant to fluid management in preterm infants by converting oliguric AKI into non-oliguric AKI.