Retrospective Evaluation of Dosing Effects of Bumetanide Continuous Infusions in the Pediatric Cardiac Intensive Care Unit

OBJECTIVE: Bumetanide is commonly used to achieve diuresis and alleviate fluid overload in pediatric cardiac intensive care unit (PCICU) patients. This study aims to describe the dosing, efficacy, and safety of bumetanide continuous infusion (CI) regimens used in PCICU patients.

METHODS: This single center, retrospective study included patients <6 years of age, admitted to the PCICU who received a bumetanide CI for at least 6 hours. The primary outcome was identifying doses and the total duration of bumetanide CI regimens. Secondary efficacy outcomes were determined by the ability to achieve negative fluid balance within 24 hours and the time to reach negative fluid balance. Secondary safety outcomes were based on the prevalence of electrolyte imbalances and renal impairment.

RESULTS: Data from 90 pediatric patients represented 106 hospital encounters in this study. The median age of our study population was 137 days, with a median weight of 4.3 kg. The dose ranged from 0.005 mg/kg/hr to 0.3 mg/kg/hr, with a median dose of bumetanide of 0.046 mg/kg/hr and a median duration of 5.8 days. The change in serum electrolytes and creatinine during baseline and peak infusion rates was not clinically significant.

CONCLUSION: This study remains the largest pediatric study to date describing the dosing, efficacy, and safety concerns of bumetanide CI in the PCICU population. However, using a high-dose bumetanide drip >0.1 mg/kg/hr may not improve the overall outcome, and future studies can explore specific advantages of its use in neonates undergoing cardiac surgery.