The use of bumetanide for oliguric acute renal failure in preterm infants

Objective: To determine the effects of bumetanide in preterm infants with oliguric acute renal failure (OARF). Study Design: Retrospective data review and multivariate analysis of urine output and serum creatinine, blood urea nitrogen, Na, K, Cl, and Ca levels before, during, and after bumetanide therapy in preterm infants with OARF whose conditions did not respond to furosemide therapy. Results: A total of 35 infants received bumetanide for OARF after an initial trial of furosemide. Their birth weight, gestational age at birth, and postconceptional age at OARF were 811 +/- 326 g, 26 +/- 2.75 wks, and 29.2 +/- 2.7 wks, respectively. Twenty-nine of the 35 infants (83%) responded to bumetanide. Seventeen of the 35 infants subsequently died in the hospital due to multiorgan dysfunction. For the survivors (n = 18) and 11 of 17 of nonsurvivors, urine output increased from 0.6 +/- 0.6 mL/kg/hr to 3.0 +/- 2.1 mL/kg/hr during bumetanide therapy (p < .0005). Serum creatinine levels increased from 2.13 +/- 0.83 mg/dL to 2.3 +/- 0.92 mg/dL (p = .04) during bumetanide treatment, whereas blood urea nitrogen levels decreased after bumetanide therapy from 38 +/- 19 mg/dL to 31.67 +/- 21.6 mg/dL (p = .049). No significant changes were noted in serum sodium, chloride, or calcium concentration. Conclusions: Bumetanide therapy significantly increased urine output within 24-48 hrs, but its use was associated with a transient increase in serum creatinine level. Bumetanide can be used in preterm infants to reverse oliguria when therapy with furosemide fails. Prospective, randomized, controlled trials with long-term follow-up in preterm infants are necessary to establish the usefulness of bumetanide for OARF. (Pediatr Crit Care Med 2011; 12:210-214)