Estimating the effect of diuretics and inhaled corticosteroids for evolving bronchopulmonary dysplasia in preterm infants.
bronchopulmonary dysplasia
diuretics
inhaled corticosteroid
neonate
pharmacoepidemiology
preterm birth
Journal
Paediatric and perinatal epidemiology
ISSN: 1365-3016
Titre abrégé: Paediatr Perinat Epidemiol
Pays: England
ID NLM: 8709766
Informations de publication
Date de publication:
08 Jan 2024
08 Jan 2024
Historique:
revised:
15
12
2023
received:
15
05
2023
accepted:
17
12
2023
medline:
9
1
2024
pubmed:
9
1
2024
entrez:
9
1
2024
Statut:
aheadofprint
Résumé
Off-label treatment of extremely preterm infants with diuretics and inhaled corticosteroids (ICS) for evolving bronchopulmonary dysplasia (BPD) is common. Their effectiveness in reducing mortality or BPD severity, and optimal treatment timing, are unclear. To determine whether diuretic treatment or ICS administration for infants with early evolving (between 10-27 days postnatal) and progressively evolving (28th-day-36th-week postnatal) BPD are independently associated with reduced mortality and moderate or severe BPD at 36-weeks postmenstrual age (PMA). We examined neonates born before 28 weeks' gestation and admitted to neonatal intensive care units on postnatal Day 0 between 2006 and 2016 using data collected during routine care recorded within the Paediatric Health Information System (PHIS). An early evolving BPD cohort consisted of infants treated with oxygen, positive pressure or mechanical ventilation at 10 days postnatal. The progressively evolving BPD cohort consisted of infants treated with these modalities at 28 days. In new users, we evaluated the effect of diuretic and ICS treatment on mortality or BPD severity at 36 weeks PMA, adjusting for time-dependent confounding by respiratory status using marginal structural models. Early evolving BPD was present in 10,135 patients; progressively evolving BPD in 11,728. New diuretic exposure during early evolving BPD (adjusted risk ratio [aRR] 0.77, 95% confidence interval [CI] 0.65, 0.93) was associated with decreased mortality or moderate/severe BPD risk. New diuretics (aRR 0.86, 95% CI 0.75, 0.99) during progressively evolving BPD between 28-days-36-weeks PMA were less strongly associated with mortality or moderate/severe BPD reduction. There was no strong association for ICS in patients with early evolving (aRR: 1.40; 95% CI: 0.79, 2.51) or progressively evolving BPD (aRR 1.16, 95% CI 0.95, 1.49). Diuretics, but not ICS, for evolving BPD were associated with mortality and BPD risk reduction.
Sections du résumé
BACKGROUND
BACKGROUND
Off-label treatment of extremely preterm infants with diuretics and inhaled corticosteroids (ICS) for evolving bronchopulmonary dysplasia (BPD) is common. Their effectiveness in reducing mortality or BPD severity, and optimal treatment timing, are unclear.
OBJECTIVES
OBJECTIVE
To determine whether diuretic treatment or ICS administration for infants with early evolving (between 10-27 days postnatal) and progressively evolving (28th-day-36th-week postnatal) BPD are independently associated with reduced mortality and moderate or severe BPD at 36-weeks postmenstrual age (PMA).
METHODS
METHODS
We examined neonates born before 28 weeks' gestation and admitted to neonatal intensive care units on postnatal Day 0 between 2006 and 2016 using data collected during routine care recorded within the Paediatric Health Information System (PHIS). An early evolving BPD cohort consisted of infants treated with oxygen, positive pressure or mechanical ventilation at 10 days postnatal. The progressively evolving BPD cohort consisted of infants treated with these modalities at 28 days. In new users, we evaluated the effect of diuretic and ICS treatment on mortality or BPD severity at 36 weeks PMA, adjusting for time-dependent confounding by respiratory status using marginal structural models.
RESULTS
RESULTS
Early evolving BPD was present in 10,135 patients; progressively evolving BPD in 11,728. New diuretic exposure during early evolving BPD (adjusted risk ratio [aRR] 0.77, 95% confidence interval [CI] 0.65, 0.93) was associated with decreased mortality or moderate/severe BPD risk. New diuretics (aRR 0.86, 95% CI 0.75, 0.99) during progressively evolving BPD between 28-days-36-weeks PMA were less strongly associated with mortality or moderate/severe BPD reduction. There was no strong association for ICS in patients with early evolving (aRR: 1.40; 95% CI: 0.79, 2.51) or progressively evolving BPD (aRR 1.16, 95% CI 0.95, 1.49).
CONCLUSION
CONCLUSIONS
Diuretics, but not ICS, for evolving BPD were associated with mortality and BPD risk reduction.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : National Heart, Lung, and Blood Institute, National Institutes of Health
Informations de copyright
© 2024 The Authors. Paediatric and Perinatal Epidemiology published by John Wiley & Sons Ltd.
Références
Slaughter JL, Stenger MR, Reagan PB. Variation in the use of diuretic therapy for infants with bronchopulmonary dysplasia. Pediatrics. 2013;131(4):716-723.
Slaughter JL, Stenger MR, Reagan PB, Jadcherla SR. Utilization of inhaled corticosteroids for infants with bronchopulmonary dysplasia. PloS One. 2014;9(9):e106838. doi:10.1371/journal.pone.0106838
Clouse BJ, Jadcherla SR, Slaughter JL. Systematic review of inhaled bronchodilator and corticosteroid therapies in infants with bronchopulmonary dysplasia: implications and future directions. PloS One. 2016;11(2):e0148188.
Jensen EA. Prevention of bronchopulmonary dysplasia: a summary of evidence-based strategies. Neoreviews. 2019;20(4):e189-e201. doi:10.1542/neo.20-4-e189
Thomas W, Speer C. Nonventilatory strategies for prevention and treatment of bronchopulmonary dysplasia-what is the evidence? Neonatology. 2008;94(3):150-159.
Bassler D, Plavka R, Shinwell ES, et al. Early inhaled budesonide for the prevention of bronchopulmonary dysplasia. N Engl J Med. 2015;373(16):1497-1506.
Shah VS, Ohlsson A, Halliday HL, Dunn M. Early administration of inhaled corticosteroids for preventing chronic lung disease in very low birth weight preterm neonates. Cochrane Database Syst Rev. 2017;1(1):CD001969. doi:10.1002/14651858.CD001969.pub4
Onland W, Offringa M, van Kaam A. Late (≥ 7 days) inhalation corticosteroids to reduce bronchopulmonary dysplasia in preterm infants. Cochrane Database Syst Rev. 2022;12(12):CD002311. doi:10.1002/14651858.CD002311.pub5
Stewart A, Brion LP. Intravenous or enteral loop diuretics for preterm infants with (or developing) chronic lung disease. Cochrane Database Syst Rev. 2011;2011(9):CD001453. doi:10.1002/14651858.CD001453.pub2
Stewart A, Brion LP, Ambrosio-Perez I. Diuretics acting on the distal renal tubule for preterm infants with (or developing) chronic lung disease. Cochrane Database Syst Rev. 2011;2011(9):CD001817. doi:10.1002/14651858.CD001817.pub2
Ehrenkranz RA, Walsh MC, Vohr BR, et al. Validation of the National Institutes of Health consensus definition of bronchopulmonary dysplasia. Pediatrics. 2005;116(6):1353-1360.
Laughon MM, Langer JC, Bose CL, et al. Prediction of bronchopulmonary dysplasia by postnatal age in extremely premature infants. Am J Respir Crit Care Med. 2011;183(12):1715-1722.
Walsh MC, Szefler S, Davis J, et al. Summary proceedings from the bronchopulmonary dysplasia group. Pediatrics. 2006;117(3 Pt 2):S52-S56. doi:10.1542/peds.2005-0620I
Stewart A, Brion L. Routine use of diuretics in very-low birth-weight infants in the absence of supporting evidence. J Perinatol. 2011;31(10):633-634.
Ray WA. Evaluating medication effects outside of clinical trials: new-user designs. Am J Epidemiol. 2003;158(9):915-920.
Hernán MA, Alonso A, Logan R, et al. Observational studies analyzed like randomized experiments: an application to postmenopausal hormone therapy and coronary heart disease. Epidemiology. 2008;19(6):766-779.
Hernán MA, Hernández-Díaz S, Robins JM. A structural approach to selection bias. Epidemiology. 2004;15(5):615-625. doi:10.1097/01.ede.0000135174.63482.43
Slaughter JL, Reagan PB, Newman TB, Klebanoff MA. Comparative effectiveness of nonsteroidal anti-inflammatory drug treatment vs No treatment for patent ductus arteriosus in preterm infants. JAMA Pediatr. 2017;171:e164354. doi:10.1001/jamapediatrics.2016.4354
Herńan M, Robins J. Causal inference: what if. In: Hernán MA, Robins JM, eds. Causal Inference: What If. Chapman & Hall/CRC; 2020.
Robins JM, Hernan MA, Brumback B. Marginal structural models and causal inference in epidemiology. Epidemiology. 2000;11:550-560.
Bodnar LM, Davidian M, Siega-Riz AM, Tsiatis AA. Marginal structural models for analyzing causal effects of time-dependent treatments: an application in perinatal epidemiology. Am J Epidemiol. 2004;159(10):926-934. doi:10.1093/aje/kwh131
Williamson T, Ravani P. Marginal structural models in clinical research: when and how to use them? Nephrol Dial Transplant. 2017;32(suppl_2):ii84-ii90. doi:10.1093/ndt/gfw341
Sigurdson K, Mitchell B, Liu J, et al. Racial/ethnic disparities in neonatal intensive care: a systematic review. Pediatrics. 2019;144(2):e20183114. doi:10.1542/peds.2018-3114
Cole SR, Hernán MA. Constructing inverse probability weights for marginal structural models. Am J Epidemiol. 2008;168(6):656-664. doi:10.1093/aje/kwn164
Richardson DB, Kinlaw AC, MacLehose RF, Cole SR. Standardized binomial models for risk or prevalence ratios and differences. Int J Epidemiol. 2015;44(5):1660-1672. doi:10.1093/ije/dyv137
Lash TL, Rothman KJ, VanderWeele TJ, Haneuse S. Modern Epidemiology. 4th ed. Wolters Kluwer; 2021.
VanderWeele TJ, Ding P. Sensitivity analysis in observational research: introducing the E-value. Ann Intern Med. 2017;167(4):268-274. doi:10.7326/m16-2607
Haneuse S, VanderWeele TJ, Arterburn D. Using the E-value to assess the potential effect of unmeasured confounding in observational studies. Jama. 2019;321(6):602-603. doi:10.1001/jama.2018.21554
Little RJA, Rubin DB. Statistical Analysis with Missing Data. Vol 793. John Wiley & Sons; 2019.
Bamat NA, Thompson EJ, Greenberg RG, et al. Association between postmenstrual age and furosemide dosing practices in very preterm infants. J Perinatol. 2022;42(4):461-467. doi:10.1038/s41372-022-01320-w
Kelly HW, Sternberg AL, Lescher R, et al. Effect of inhaled glucocorticoids in childhood on adult height. N Engl J Med. 2012;367(10):904-912.