Lasix dose in neonate
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furosemide neonate dosing
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furosemide Lasix dose neonate neonatal 2024 guidelines
Here is a comprehensive summary of Furosemide (Lasix) dosing in neonates:
Furosemide (Lasix) Dosing in Neonates
Mechanism
Loop diuretic - inhibits the Na-K-2Cl cotransporter in the thick ascending limb of the loop of Henle.
Intermittent Dosing (IV / IM / PO)
| Gestational Age / Age | Dose | Frequency |
|---|---|---|
| Preterm < 34 weeks PMA | 1 mg/kg/dose | Every 24 hours |
| Preterm ≥ 34 weeks PMA | 1 mg/kg/dose | Every 12-24 hours |
| Term neonate (0-30 days) | 1-2 mg/kg/dose | Every 12 hours |
| Term infant > 30 days | 1-2 mg/kg/dose | Every 8-12 hours |
PMA = postmenstrual age (corrected gestational age)
Key rule: Neonates ≤ 32 weeks postconceptional age - use 1 mg/kg/dose IV every 24 hours only (risk of accumulation due to immature renal clearance).
Doses may be titrated up to 2 mg/kg/dose every 6 hours in term infants with significant fluid overload or heart failure. For oral use in heart failure, up to 6 mg/kg/dose has been described.
Continuous IV Infusion
| Parameter | Value |
|---|---|
| Loading dose | None |
| Initial rate | 0.1 mg/kg/hour |
| Titration | 0.1 mg/kg/hour every 12-24 hours |
| Usual range | 0.1 - 0.4 mg/kg/hour |
| Maximum | 0.4 mg/kg/hour |
For diuresis renography: 1 mg/kg stat (given as IV push).
Administration
- IV bolus: Infuse over 2-4 minutes; do not exceed 0.5 mg/kg/min or 4 mg/min
- Oral bioavailability: ~50% (dose accordingly when switching IV to PO)
- Protect IV solution from light
Important Notes
- Renal clearance is the primary elimination route - accumulation occurs in renal failure; reduce frequency or avoid if significant renal impairment
- PDA caution: Conflicting evidence on concurrent use with symptomatic patent ductus arteriosus - furosemide stimulates renal prostaglandin E2 synthesis, which may actually delay PDA closure
- Ototoxicity risk: Particularly when used with aminoglycosides; higher cumulative doses increase risk
- Nephrocalcinosis: Prolonged use, especially in premature infants, raises risk - screen with renal ultrasound for infants on extended therapy
Monitoring
- Urine output and fluid balance
- Weight (daily)
- Serum sodium, potassium, calcium, magnesium, chloride
- Renal function (BUN, creatinine)
- Renal ultrasound for nephrocalcinosis in preterm infants on prolonged therapy
Adverse Effects
- Hypovolemia
- Electrolyte disturbances: hyponatremia, hypokalemia, hypocalcemia, hypomagnesemia, hypochloremic metabolic alkalosis
- Nephrocalcinosis (chronic use)
- Ototoxicity (dose-related, risk increases with aminoglycoside co-use)
Sources: IWK Neonatal Drug Dosing Guidelines, PedMed Furosemide Neonatal, ANMF Consensus Group Neonatal Furosemide, PDR Drug Summary
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