J Pediatr Intensive Care
DOI: 10.1055/s-0042-1755443
Original Article

The Effect of Aminophylline on Urine Output and Fluid Balance after a Single Dose in Children Admitted to the Pediatric Cardiac Intensive Care Unit

1   Cardiology, Pediatrics, Advocate Children's Hospital, Oak Lawn, Illinois, United States
,
Sruti Uppuluri
1   Cardiology, Pediatrics, Advocate Children's Hospital, Oak Lawn, Illinois, United States
,
Priya Chandra
1   Cardiology, Pediatrics, Advocate Children's Hospital, Oak Lawn, Illinois, United States
,
Faeeq Yousef
1   Cardiology, Pediatrics, Advocate Children's Hospital, Oak Lawn, Illinois, United States
,
Vincent Dorsey
1   Cardiology, Pediatrics, Advocate Children's Hospital, Oak Lawn, Illinois, United States
,
2   Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo Leon, Mexico
,
3   Critical Care and Cardiology, Pediatrics, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas, United States
,
2   Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo Leon, Mexico
› Author Affiliations

Abstract

The purpose of this retrospective study was to investigate the effects of a single dose of aminophylline on urine output and fluid balance in children admitted to the cardiac intensive care unit. A retrospective study was performed to compare variables of interest before and 24 hours after aminophylline administration in children under the age of 18 years who were admitted to the cardiac intensive care unit at our institution from January 2011 onwards. Variables of interest included age, weight, aminophylline dose, concurrently administered diuretics, specific hemodynamic parameters, and blood urea nitrogen and creatinine levels. Variables such as urine output and fluid balance were measured through a binary endpoint. Data were compared in a paired fashion and continuous variables were compared through paired t-tests. Analyses were conducted using SPSS Version 23.0. A total of 14 patients were included in the study. There was no significant change in hemodynamic parameters or creatinine levels before and after intravenous aminophylline administration of 5 mg/kg. There was a significant difference in urine output, fluid balance, and blood urea nitrogen levels from the baseline value. Concurrent usage of diuretics did not show significant association with a difference in urine output or fluid balance from baseline. No significant adverse reactions were noted 24 hours after administration of aminophylline. Use of aminophylline dosed at 5 mg/kg is safe and leads to improvement in urine output and fluid balance without negatively impacting systemic oxygen delivery or renal filtration function.



Publication History

Received: 15 December 2021

Accepted: 24 June 2022

Article published online:
14 September 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
  • References

  • 1 Hassinger AB, Wald EL, Goodman DM. Early postoperative fluid overload precedes acute kidney injury and is associated with higher morbidity in pediatric cardiac surgery patients. Pediatr Crit Care Med 2014; 15 (02) 131-138
  • 2 Kwiatkowski DM, Axelrod DM, Sutherland SM, Tesoro TM, Krawczeski CD. Dexmedetomidine is associated with lower incidence of acute kidney injury after congenital heart surgery. Pediatr Crit Care Med 2016; 17 (02) 128-134
  • 3 Lex DJ, Tóth R, Czobor NR. et al. Fluid overload is associated with higher mortality and morbidity in pediatric patients undergoing cardiac surgery. Pediatr Crit Care Med 2016; 17 (04) 307-314
  • 4 Pretzlaff RK, Vardis RJ, Pollack MM. Aminophylline in the treatment of fluid overload. Crit Care Med 1999; 27 (12) 2782-2785
  • 5 Goldstein S, Bagshaw S, Cecconi M. et al; ADQI XII Investigators Group. Pharmacological management of fluid overload. Br J Anaesth 2014; 113 (05) 756-763
  • 6 Foote HP, Hornik CP, Hill KD, Rotta AT, Chamberlain R, Thompson EJ. A systematic review of the evidence supporting post-operative diuretic use following cardiopulmonary bypass in children with congenital heart disease. Cardiol Young 2021; 31 (05) 699-706
  • 7 Bell M, Jackson E, Mi Z, McCombs J, Carcillo J. Low-dose theophylline increases urine output in diuretic-dependent critically ill children. Intensive Care Med 1998; 24 (10) 1099-1105
  • 8 Flores S, Culichia CN, Villarreal EG, Savorgnan F, Checchia PA, Loomba RS. Xanthine derivatives for kidney protection in the critically ill pediatric population: a systematic review. J Pediatr Intensive Care 2020; 9 (03) 155-161
  • 9 Bronicki RA, Flores S, Loomba RS. et al. Impact of corticosteroids on cardiopulmonary bypass induced inflammation in children: a meta-analysis. Ann Thorac Surg 2021; 112 (04) 1363-1370
  • 10 Flores S, Bronicki RA, Loomba RS. Early identification of myocardial reperfusion injury after cardiopulmonary bypass: toward the final frontier of congenital heart surgery. Pediatr Crit Care Med 2021; 22 (09) 852-854
  • 11 Becker AC, Lantz CW, Forbess JM, Epting CL, Thorp EB. Cardiopulmonary bypass-induced inflammation and myocardial ischemia and reperfusion injury stimulates accumulation of soluble MER. Pediatr Crit Care Med 2021; 22 (09) 822-831
  • 12 Hirata Y. Cardiopulmonary bypass for pediatric cardiac surgery. Gen Thorac Cardiovasc Surg 2018; 66 (02) 65-70
  • 13 Jo YY, Kim JY, Lee JY, Choi CH, Chang YJ, Kwak HJ. The effect of intraoperative dexmedetomidine on acute kidney injury after pediatric congenital heart surgery: a prospective randomized trial. Medicine (Baltimore) 2017; 96 (28) e7480
  • 14 Wilder NS, Yu S, Donohue JE, Goldberg CS, Blatt NB. Fluid overload is associated with late poor outcomes in neonates following cardiac surgery. Pediatr Crit Care Med 2016; 17 (05) 420-427
  • 15 Axelrod DM, Anglemyer AT, Sherman-Levine SF. et al. Initial experience using aminophylline to improve renal dysfunction in the pediatric cardiovascular ICU. Pediatr Crit Care Med 2014; 15 (01) 21-27
  • 16 Onder AM, Rosen D, Mullett C. et al. Comparison of intraoperative aminophylline versus furosemide in treatment of oliguria during pediatric cardiac surgery. Pediatr Crit Care Med 2016; 17 (08) 753-763
  • 17 Axelrod DM, Sutherland SM, Anglemyer A, Grimm PC, Roth SJA. A double-blinded, randomized, placebo-controlled clinical trial of aminophylline to prevent acute kidney injury in children following congenital heart surgery with cardiopulmonary bypass. Pediatr Crit Care Med 2016; 17 (02) 135-143
  • 18 Costello JM, Thiagarajan RR, Dionne RE. et al. Initial experience with fenoldopam after cardiac surgery in neonates with an insufficient response to conventional diuretics. Pediatr Crit Care Med 2006; 7 (01) 28-33
  • 19 Ricci Z, Luciano R, Favia I. et al. High-dose fenoldopam reduces postoperative neutrophil gelatinase-associated lipocaline and cystatin C levels in pediatric cardiac surgery. Crit Care 2011; 15 (03) R160
  • 20 Villarreal EG, Rausa J, Chapel AC, Loomba RS, Flores S. Effects of fenoldopam in the pediatric population: fluid status, serum biomarkers, and hemodynamics: a systematic review and meta-analysis. J Pediatr Intensive Care 2021; 10 (02) 118-125
  • 21 Rausa J, Rohit L, Dorsey V. et al. Use of fenoldopam in children with congenital heart disease to decrease fluid balance: a retrospective, descriptive study and insights into predictors of decreased fluid balance. J Pediatr Intensive Care 2021
  • 22 Loomba RS, Villarreal EG, Dhargalkar J. et al. The effect of dexmedetomidine on renal function after surgery: A systematic review and meta-analysis. J Clin Pharm Ther 2022; 47 (03) 287-297
  • 23 da Silva PS, de Aguiar VE, Fonseca MC. Additive diuretic response of concurrent aminophylline and furosemide in children: a case series and a brief literature review. J Anesth 2012; 26 (01) 118-123
  • 24 Tamburro RF, Thomas NJ, Ceneviva GD, Dettorre MD, Brummel GL, Lucking SE. A prospective assessment of the effect of aminophylline therapy on urine output and inflammation in critically ill children. Front Pediatr 2014; 2: 59
  • 25 Mazkereth R, Laufer J, Jordan S, Pomerance JJ, Boichis H, Reichman B. Effects of theophylline on renal function in premature infants. Am J Perinatol 1997; 14 (01) 45-49
  • 26 Baker MD. Theophylline toxicity in children. J Pediatr 1986; 109 (03) 538-542
  • 27 Chakravarti SB, Mittnacht AJ, Katz JC, Nguyen K, Joashi U, Srivastava S. Multisite near-infrared spectroscopy predicts elevated blood lactate level in children after cardiac surgery. J Cardiothorac Vasc Anesth 2009; 23 (05) 663-667
  • 28 Hoffman GM, Ghanayem NS, Scott JP, Tweddell JS, Mitchell ME, Mussatto KA. Postoperative cerebral and somatic near-infrared spectroscopy saturations and outcome in hypoplastic left heart syndrome. Ann Thorac Surg 2017; 103 (05) 1527-1535
  • 29 Dabal RJ, Rhodes LA, Borasino S, Law MA, Robert SM, Alten JA. Inferior vena cava oxygen saturation monitoring after the Norwood procedure. Ann Thorac Surg 2013; 95 (06) 2114-2120 , discussion 2120–2121
  • 30 Scott JP, Hoffman GM. Near-infrared spectroscopy: exposing the dark (venous) side of the circulation. Paediatr Anaesth 2014; 24 (01) 74-88
  • 31 Loomba RS, Rausa J, Sheikholeslami D. et al. Correlation of near-infrared spectroscopy oximetry and corresponding venous oxygen saturations in children with congenital heart disease. Pediatr Cardiol 2022; 43 (01) 197-206