Furosemide for Packed Red Cell Transfusion in Preterm Infants: AÂ Randomized Controlled Trial

ObjectiveTo 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 designA 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.ResultsThe 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.ConclusionsRoutine 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.