Furosemide neonates

In a commentary on this trial (28) it was pointed out that the use of acetazolamide alone or with furosemide in the treatment of posthemorrhagic hydrocephalus is another example of the use of untried therapy in neonatal care. The safety and efficacy of acetazolamide in children has never been established. 

Furosemide passes into the breast milk in a concentration 80% of that in serum at pH 7.0, but the total amount of drug ingested is probably too low to affect the neonate (25). 

Results from animal studies indicate that while furosemide enhanced cephaloridine nephrotoxicity no increased renal toxicity was observed by combining of piperacillin with furosemide [142]. Latamoxef and flo-moxef may decrease nephrotoxicity of vancomycin by inhibiting its uptake into the kidney [146,147]. The results of a retrospective study including renal transplant patients indicate that aztreonam can be safely administered with cyclosporine [148]. Combination therapy with ampicillin/aztreonam in neonates showed a lower renal toxicity than in the group with concurrent administration of oxacillin/ amikacin [149]. 

Sidhu, J.S. Charles, B.G. Simple microscale high-performance liquid chromatographic method for determination of furosemide in neonatal plasma. J.Chromatogr., 1993, 612, 161-165... 

Four premature neonates, two given oral and two given intravenous theophylline with furosemide had a fall in steady-state serum theophylline levels from 8 mg/L down to 2 to 3 mg/L when furosemide was given within 30 minutes of the theophylline. ... 

Urinary tract Administration of furosemide to preterm infants may increase the risk of nephrocalcinosis. In 55 neonates bom before 32 weeks of gestation a multivariate analysis showed that the strongest independent susceptibility factor for nephrocalcinosis was furosemide therapy in a cumulative dose of over lOmg/kg (OR=48 95% Cl = 4, 585) [13 ]. The risk of nephrocalcinosis increased in proportion to the urinary calcium concentration (OR=4.5 for each 1 mmol/1 increase 95% Cl = 1.1,18). 

Lee BS, Byun SY, Chung ML, Chang JY, Kim HY, Kim EA, Kim KS, Pi SY. Effect of furosemide on ductal closure and renal function in indomethacin-treated preterm infants during the early neonatal period. Neonatology 2010 98(2) 191-9. 

Pacifici GM. Clinical pharmacology of furosemide in neonates a review. Pharmaceuticals 2013 6(9) 1094-129. 

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