Early Diuretic Administration After Neonatal Cardiac Surgery and Association with Clinical Outcomes: A Report from NEPHRON

ObjectiveThis study aimed to investigate associations between early diuretic administration following neonatal cardiac surgery and clinical outcomes.MethodsThis was a retrospective cohort study including neonates who underwent cardiac surgery within the first 30 postnatal days between September 2015 and January 2018 at 22 centers participating in the Pediatric Cardiac Critical Care Consortium (PC⁴) and Neonatal and Pediatric Heart and Renal Outcomes Network (NEPHRON) registries. Multivariable logistic and ordinal regression models were used to assess associations between early diuretic administration [defined as receipt of furosemide in the operating room and/or any diuretic on postoperative day 0 (POD0)] and outcomes. Outcomes: peak cumulative fluid balance, delay in achieving first negative daily fluid balance, duration of mechanical ventilation, hospital length of stay (LOS), and severe persistent acute kidney injury (AKI). An additional exploratory analysis was performed to assess for association between receiving enteral diuretic within the study period (POD0-6) and hospital LOS.ResultsOf 2240 neonates, 63% (n = 1405) had early diuretic administration and 15% (n = 344) received enteral diuretics. After adjusting for covariates and center effect, early diuretic administration was associated with shorter duration of mechanical ventilation [Odds Ratio (OR) = 0.59, 95% confidence interval (95%CI) 0.42-0.82] and a lower odds of delay in negative daily fluid balance (OR = 0.44, 95%CI 0.26-0.75), but not severe persistent AKI. Receiving enteral diuretic by POD6 was associated with decreased hospital LOS (OR = 0.3, 95%CI 0.23-0.41).ConclusionsEarly diuretic administration is associated with earlier time to negative daily fluid balance and shorter duration of mechanical ventilation. Efforts to standardize early diuretic administration have the potential to decrease resource utilization and warrants further study.