Effect of Oral Diuretics on Pulmonary Mechanics in Infants with Chronic Bronchopulmonary Dysplasia: Results of a Double-Blind Crossover Sequential Trial

In a randomized double-blind crossover trial with sequential analysis, the effects of oral diuretics were compared with the effects of placebo on pulmonary mechanics in ten infants with bronchopulmonary dysplasia (BPD). Pulmonary mechanics were measured before and at the end of a week of treatment with oral diuretics (chlorothiazide, 20 mg/kg/dose and spironolactone, 1.5 mg/kg/dose) given twice daily, or placebo. Mean airway resistance decreased 35.3 cm H2O/L/s, mean specific airway conductance increased 0.095 1/L/s/cm H2O, and mean dynamic pulmonary compliance increased 1.74 mL/cm H2O during treatment with diuretics (all P <.001), but not during treatment with placebo. The infants' rate of weight gain decreased on the first three days of diuretic treatment, but was thereafter comparable with weight gain during treatment with placebo. Fluid intake was similar in infants receiving diuretics and placebo. But, infants receiving diuretics not only had significantly increased urine output, osmolal clearance, and potassium and phosphorus excretion, but these infants also retained less fluid, and, in addition, excreted less calcium than infants receiving placebo. It is concluded that oral diuretics improve lung function in infants with chronic bronchopulmonary dysplasia; however, potassium and phosphorus depletion are potential complications of treatment.

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Letter to the Editor

PEDIATRICS ◽

10.1542/peds.72.2.267b ◽

1983 ◽

Vol 72 (2) ◽

pp. 267-267

Author(s):

Iréne Jakobsson

Keyword(s):

Statistical Method ◽

Sequential Analysis ◽

Crossover Trial ◽

Cow’S Milk ◽

Double Blind ◽

Cow's Milk ◽

Letter To The Editor

Our study was performed in 66 infants and mothers. The mothers of 23 infants with cow's milk-related colic were asked to participate in the double-blind crossover trial, and 16 accepted. The results of the trial were expressed according to the rules of sequential analysis, a statistical method considered to be useful in a study like ours (references to the method were given in our paper). According to these rules the study should be completed as soon as any line of the sequential chart had been passed.

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Effect of Ibuprofen on Blood Pressure Control by Propranolol and Bendrofluazide

Journal of International Medical Research ◽

10.1177/030006058801600302 ◽

1988 ◽

Vol 16 (3) ◽

pp. 173-181 ◽

Cited By ~ 8

Author(s):

J. G. Davies ◽

D. C. Rawlins ◽

M. Busson

Keyword(s):

Blood Pressure ◽

Weight Gain ◽

Crossover Trial ◽

Antihypertensive Effect ◽

Pressure Control ◽

Double Blind ◽

Randomized Crossover Trial ◽

Significant Difference ◽

Change In Mean ◽

Drug Free

The effect of 1600 mg/day ibuprofen in two groups of patients with hypertension controlled by either propranolol or bendrofluazide was studied in a double-blind, double-placebo, randomized crossover trial. No significant difference in blood pressure was found at the end of the crossover period in either group, suggesting that the routine co-administration of ibuprofen does not attenuate the antihypertensive effect of thiazide diuretics or propranolol. Significant weight gain, attributable to fluid retention, had occurred in the bendrofluazide-treatment group by the end of the drug-free washout period. No significant change in mean weight occurred in the crossover stages in either group, although substantial weight gain was noted during ibuprofen treatment in two patients given bendrofluazide and one given propranolol. Biochemical variables were unaffected by ibuprofen throughout the crossover period. This study suggests that ibuprofen may be administered routinely to patients receiving thiazides or propranolol without loss of control of the anti-hypertensive action of these drugs but it is recommended that individuals are monitored for possible weight gain or an increase in diastolic blood pressure.

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Effect of Isoproterenol Inhalation on Airway Resistance in Chronic Bronchopulmonary Dysplasia

PEDIATRICS ◽

10.1542/peds.73.4.509 ◽

1984 ◽

Vol 73 (4) ◽

pp. 509-514

Author(s):

Lily C. Kao ◽

David Warburton ◽

Arnold C. G. Platzker ◽

Thomas G. Keens

Keyword(s):

Mechanical Ventilation ◽

Bronchopulmonary Dysplasia ◽

Airway Resistance ◽

Hyaline Membrane Disease ◽

Pulmonary Mechanics ◽

Quiet Breathing ◽

Pulmonary Compliance ◽

Thoracic Gas Volume ◽

Gas Volume ◽

Airway Conductance

The effects of isoproterenol inhalation on pulmonary mechanics in ten infants with bronchopulmonary dysplasia (BPD), aged 41 ± 1 (SE) weeks postconception, with gestational age at birth 30 ± 1 weeks, and birth weight 1,590 ± 200 g were studied. The infants had: (1) hyaline membrane disease requiring mechanical ventilation in the first five days of life, (2) mechanical ventilation and/or FIO2 greater than 30% for at least 30 days, and (3) stage III or IV radiographic changes. Thoracic gas volume, airway resistance, and specific airway conductance were measured in an infant body pressure plethysmograph during quiet breathing. Dynamic pulmonary compliance was measured using an esophageal balloon. These infants with BPD had greater airway resistance, lower specific airway conductance, and lower dynamic pulmonary compliance than 16 normal control infants (age 40 ± 1 weeks postconception). In the infants with BPD, measurements were obtained before and ½, 1, 2, and 6 hours after the administration of isoproterenol aerosol 0.1% inhalation or saline aerosol placebo, five breaths by slow inflation of the lungs with an anesthesia bag. Within 30 minutes after isoproterenol inhalation, airway resistance decreased 28% ± 5% and specific airway conductance increased 53% ± 15%. Thoracic gas volume and dynamic pulmonary compliance did not change. There were no changes following administration of the placebo. Isoproterenol inhalation is associated with rapid short-term improvement in airway resistance and specific airway conductance in infants with BPD.

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