Outpatient Diuretic Use and Respiratory Outcomes in Children with Bronchopulmonary Dysplasia During the First Three Years of Life.

Objective: To investigate the link between outpatient respiratory outcomes in children with bronchopulmonary dysplasia (BPD) who are prescribed outpatient diuretics versus those who are not at the time of their initial pediatric pulmonary clinic visit.

Study Design: Patient data were gathered by chart review and validated questionnaires on 1,002 children with BPD discharged between 2008 and 2023 seen at the Children's Hospital of Philadelphia and Johns Hopkins Children's Center outpatient pediatric pulmonary clinics.

Results: Children prescribed outpatient diuretics (n=634) at time of first pulmonary appointment were more likely to have severe BPD and require home supplemental oxygen. Outpatient diuretic therapy was associated with initial hospital discharge at an older age, but an earlier first pulmonary clinic visit. Children between 0 to 3 years prescribed one or two diuretics were less likely to be readmitted to the hospital for respiratory reasons than those not on diuretics. There was no difference in healthcare utilization for those on three diuretics compared with those not on diuretics. Children weaned off diuretics by a caregiver compared with a healthcare provider had a higher odds of being readmitted to the hospital for respiratory reasons.

Conclusions: For children with BPD, a modest reduction in rehospitalization was associated with being on one or two diuretics at their initial outpatient visit. However, no difference in chronic respiratory symptoms was observed between children receiving diuretics and those who were not. Caregiver-led weaning of diuretics was associated with a higher risk of rehospitalization compared with weaning by the healthcare provider.