Variation in the use of diuretic therapy for infants with bronchopulmonary dysplasia

Abstract

Objectives: To determine (1) between-hospital variation in diuretic use for infants with bronchopulmonary dysplasia (BPD), including hospital-specific treatment frequency, treatment duration, and percentage of infants receiving short (≤5 consecutive days) versus longer (>5 days) courses, and to determine (2) demographic and clinical variables associated with diuretic administration.

Methods: A retrospective cohort study was conducted with the use of the Pediatric Health Information System to determine between-hospital variation in diuretic utilization patterns (primary outcome) and variables associated with diuretic use among <29-week-gestation infants with evolving BPD at age 28 days who were discharged between January 2007 and June 2011.

Results: During the 54-month study period, 1429 infants within 35 hospitals met the inclusion criteria for BPD at age 28 days, with 1222 (86%) receiving diuretic therapy for a median of 9 days (25th-75th percentile: 2-33 days). Short courses were administered to 1203 (83%) infants, and 570 (40%) infants received treatment for >5 consecutive days. Furosemide was the most widely prescribed diuretic (1218 infants; 85%), although chlorothiazide had the longest median duration of use (21 days; 25th-75th percentile: 8-46 days). The range of infants receiving a diuretic course of >5 days duration varied by hospital from 4% to 86%, with wide between-hospital variation even after adjustment for confounding variables.

Conclusions: The frequency of diuretic administration to infants with BPD at US children's hospitals, as well as the specific diuretic regimen used, varies markedly by institution. Safety and effectiveness research of long-term diuretic therapy for BPD patients is needed to develop evidence-based recommendations.

FIGURE 1

Percentage of infants with BPD receiving a ≤5-consecutive-day short course or >5-day course of diuretics by day of hospitalization.

FIGURE 2

Mean proportion of days that infants received diuretics during their NICU stay, by hospital. Range: 5.1% to 61.9%. Patient days = (mean patient days on any diuretic/mean length of stay). Hospitals were excluded if <15 patients developed BPD during the study period.

FIGURE 3

Percentage of patients by hospital who ever received a ≤5-day short course of diuretics or a course >5 days. Ranges: longer courses, 3.9% to 86% (median: 42.4%); short courses, 62.7% to 91.7% (median: 89.9%). Hospitals are listed in order of increasing >5-day courses.

FIGURE 4

Percentage of infants by hospital who ever received a >5-consecutive-day course of chlorothiazide, furosemide, hydrochlorothiazide, or spironolactone. Hospitals are listed in order of increasing >5-day courses.