Pre-Post Implementation Study of Chronic Diuretic Clinical Practice Guideline for Bronchopulmonary Dysplasia in Preterm Infants

Background Chronic diuretics are frequently used (off-label) in preterm infants to manage evolving or established bronchopulmonary dysplasia (BPD). Chronic diuretic use, however, is limited by tolerance with no long-term safety and efficacy data, leading to wide variation in its use in preterm infants. Objective To determine the impact of the chronic diuretic clinical practice guideline (CPG) on the patterns of diuretic use, severity of BPD, and hospital length of stay (LOS) in preterm infants born less than 32 weeks gestation. Methods Single-center retrospective pre-post CPG cohort study in a level IV neonatal intensive care unit. Chronic diuretic CPG was implemented in November 2021 and the data was collected one year before (Pre-CPG) and one year after (Post-CPG). Results In total, 73 infants (39 Pre-CPG, and 34 Post-CPG) were identified. There were no significant differences in patient characteristics at birth or in the use and duration of respiratory support between the two groups. Compared to Pre-CPG, the frequency of thiazide diuretic use was not decreased in Post-CPG (30.8 vs. 20.6%, p=0. 42), but the duration of use was significantly reduced (35 vs. 6 days, p=0.01). Both frequency (20.5 vs. 2.9%) and duration (28.5 vs. 4 days) of spironolactone were reduced in the Post-CPG (p< 0.05). Furosemide exposure (69.2 vs. 41.2, p=0.02) and total doses [3.0 (0.0-8.0) vs. 0.0 (0.0-2.3), p=0.003] were also significantly reduced in the Post-CPG. The incidence of any BPD at 36 weeks and LOS were similar between groups, while the incidence of moderate/severe BPD and home oxygen use were decreased in the Post-CPG. Conclusions Chronic diuretic CPG was associated with a reduction in diuretic exposure in preterm infants