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Evidence-Based Practice Briefs: Is Lasix After a Blood Transfusion Necessary?
Heather E. Elser PhD, RN, NNP-BC, CNS
Jacqueline McGrath

Advances in Neonatal Care
December 2012 
Volume 12  Number 6
Pages 369 - 370
  PDF Version Available!

More than 80% of premature infants cared for in the intensive care nursery receive at least 1 blood transfusion.1 Multiple blood draws causing anemia2 and the need for increasing oxygen-carrying capacity3 are the 2 main reasons for infants to receive a blood transfusion. Intravascular fluid overload posttransfusion is a concern and a common practice in many facilities is to administer a dose of furosemide (Lasix).4 The aim of this column was to evaluate the evidence for administering furosemide after a blood transfusion in premature infants.A PubMed search included the search terms "Lasix" or "furosemide" and "blood transfusion" or "blood transfusions" with the limitations of English language in the ages of birth to 23 months. This search yielded 15 articles that, once reviewed, reduced to 6 articles that specifically addressed furosemide use with blood transfusions. Of these 6 articles, only 3 were empirical studies.Furosemide is a loop diuretic that inhibits the reabsorption of sodium and chloride in the tubules of the kidneys. Water follows sodium and chloride, which increases urine output and should decrease any pulmonary complications due to an increased blood volume from the blood transfusion. Adverse effects of furosemide include hypochloremia, osteopenia, nephrocalcinosis,5 and ototoxicity.6 Maintaining sodium levels within normal limits in premature infants can be difficult7 and these infants are also at risk for ototoxicity due to other antibiotics such as gentamicin. Therefore, examining the necessity for the use of furosemide post-blood transfusion is necessary.To date, 3 studies have assessed the utility of furosemide post-blood transfusion. Two of the 3 studies were double-blind, randomized, placebo-controlled trials. In the first study, 20 infants born less than 28 weeks' gestation were randomized into either a placebo group or a furosemide group.2 No differences were found between the 2 groups on the basis of neonatal characteristics. All blood transfusions

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