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Spironolactone Treatment in BPD
Pulmonary Function and Electrolyte Balance Following Spironolactone Treatment in Preterm Infants with Chronic Lung Disease: A Double-blind Placebo-controlled Randomized Trial. Hoffman DJ, Gerdes JS, and Abbasi SA. J Perinatol 2000;1:41-45.
Diuretic therapy is a commonly used adjunctive treatment for chronic lung disease in premature babies. This study examined whether the combination of chlorothiazide plus spironolactone was better than chlorothiazide alone. Study patients were also given supplemental sodium if their serum sodium was < 130, and supplemental KCl if their serum potassium was < 3.5 or their serum chloride was <95. There was no difference between the two groups in pulmonary compliance, resistance or tidal volume. Also the serum sodium and potassium, and the FIO2 were not statistically different between the two groups. The incidence or quantity of sodium or potassium chloride supplementation did not differ between the groups either. Since spironolactone acts as on aldosterone antagonist, the authors speculate that the ineffectiveness of spironolactone is related to the relative unresponsiveness of the premature kidney to the effects of aldosterone.
Comment. Spironolactone has been commonly added to the treatment regimen of premature babies with chronic lung disease without good clinical data to support its efficacy. It now appears that the addition of this drug neither improves pulmonary function nor electrolyte problems in these patients. Unless these findings are refuted by future studies, we would be wise to avoid the use of this drug in premature babies with chronic lung disease. This will lower the cost of treating these babies, and it will avoid potential complications from this therapy.
Andrew B. Kairalla MD