The Role of Outpatient Diuretic Therapy in Bronchopulmonary Dysplasia

项目摘要 美国每年有超过30万婴儿早产，其中， 大约50 000人由于早产而患上慢性呼吸道疾病。最 常见的呼吸道表现是支气管肺发育不良（BPD），其影响肺泡， 气道和肺血管发育。有限的数据表明， 患有BPD的儿童的百分比将有长期的呼吸道症状持续到成人 肺功能轨迹改变的人然而，预测呼吸道疾病的病程 目前，在整个生命周期中，BPD儿童的治疗是困难的， 首次出院后门诊管理的变化。最常见的一 药物治疗的类型是利尿剂。理论上，利尿剂可以减少 肺，从而减少呼吸的工作。然而，有相互矛盾的证据表明， 在新生儿重症监护病房使用利尿剂的益处/风险，几乎没有数据或 在医院外使用这些药物的指南。持续之 长期利尿剂在早产儿中广泛使用可能有益也可能无益的争论 在住院患者中，我们的目标是使用“真实世界”的数据来评估门诊患者是否使用 利尿剂可降低早产儿和年轻人的急性和慢性呼吸道疾病发病率 2岁以下的儿童，以及他们是否与副作用有关 发育受损在目标1中，我们假设在生命的前2年使用利尿剂 将导致较少的紧急护理使用（例如，急诊和再入院） 以及减少慢性呼吸道症状（例如，活动受限和呼吸困难）。 在目标2中，我们假设在初始NICU后的第一年内使用利尿剂 排放将导致生长受损。这些研究将有助于我们理解 以及BPD儿童门诊利尿剂使用指南。

PROJECT SUMMARY More than 300,000 infants are born prematurely in the U.S. each year, and of these, approximately 50,000 develop chronic respiratory disease due to their prematurity. The most common respiratory manifestation is bronchopulmonary dysplasia (BPD), which affects alveolar, airway, and pulmonary vascular development. Limited data suggests that a substantial percentage of children with BPD will have long-term respiratory symptoms persisting into adult life with altered lung function trajectories. However, predicting the course of respiratory disease in children with BPD throughout the lifespan is currently difficult, compounded by the wide variation in outpatient management after initial hospital discharge. One of the most common types of medical management are diuretics. Theoretically, diuretics reduce interstitial fluid within the lungs, thus decreasing work of breathing. However, there is conflicting evidence regarding the benefits/risks of diuretic use within the neonatal intensive care unit, and virtually no data or guidelines for the use of these medications outside of the hospital. In light of the ongoing controversy that broad use of long-term diuretics in preterm infants may or may not be beneficial in the inpatient setting, our goal is to use “real-world” data to assess whether the outpatient use of diuretics reduce acute and chronic respiratory morbidities in preterm infants and young children less than 2 years of age and whether they are associated with the side effect of impaired growth. In Aim 1, we hypothesize that the use of diuretics during the first 2 years of life will result in less acute care use (e.g., emergency department visits and hospital readmissions) and decreased chronic respiratory symptoms (e.g., activity limitations and difficulty breathing). In Aim 2, we hypothesize that the use of diuretics during the first year after initial NICU discharge will result in impairment of growth. These studies will help direct our understanding and guidance for the use of outpatient diuretic use in children with BPD.