To assess the effect of furosemide administered with packed red blood cell transfusion on cardiopulmonary variables of hemodynamically stable, electively transfused preterm infants beyond the first week of life.Study design
A randomized, stratified, double-blind, placebo-controlled trial of intravenous furosemide (1 mg/kg) versus placebo (normal saline) just before “top-up” packed red blood cell transfusion (20 mL/kg over 4 hours) in a tertiary neonatal intensive care unit.Results
The primary outcome was a change in fraction of inspired oxygen (FiO2) during the 24 hours posttransfusion compared with the 6-hour pretransfusion period. Secondary outcomes were functional echocardiographic and clinical/biochemical variables. Of 51 consecutive preterm infants with mean (± SD) birth weights of 900 g (± 28); enrollment weights of 1342 g (± 432); birth gestation of 27 weeks (± 1); and postmenstrual age of 32 weeks (± 4), 40 completed the study. Pretransfusion variables were comparable between the furosemide (n = 21) and placebo (n = 19) groups. There was a small but significant increase (P < .05) in posttransfusion FiO2 in placebo (relative increase of 7%, equivalent to an absolute increase from 0.27 to 0.29) compared with the furosemide group. Other variables were similar. No infant received open-label furosemide.Conclusions
Routine furosemide in electively transfused preterm infants confers minimal clinical benefits. Prevention of a clinically insignificant FiO2 rise needs to be balanced against potential adverse effects.