About

Nicolas A Bamat, MD MSCE, is an Assistant Professor of Pediatrics specializing in Neonatology and Newborn Services at the Children's Hospital of Philadelphia. He is an attending physician at both the Children's Hospital of Philadelphia and the Hospital of the University of Pennsylvania. Dr. Bamat is a core faculty member in Clinical Futures at the Children's Hospital of Philadelphia. His educational background includes a Bachelor of Arts in Psychology and Neuroscience from Williams College, obtained in 2004, followed by an MD from the University of Pennsylvania School of Medicine in 2010, and a Master of Science in Clinical Epidemiology from the same institution in 2017. His research focuses on neonatal care, including the management of preterm infants, respiratory support strategies, and pharmacokinetic studies in pediatric populations. Dr. Bamat has contributed to numerous publications in his field, emphasizing outcomes in neonatal respiratory therapy and medication use in infants with severe bronchopulmonary dysplasia.

Research topics

• Medicine
• Pediatrics
• Intensive care medicine
• Anesthesia
• Emergency medicine

Selected publications

• Outpatient Medication Prescribing Patterns in Bronchopulmonary Dysplasia: A Survey of Clinical Practices and Challenges

  Pediatric Pulmonology · 2026-04-01

  article

  OBJECTIVE: To understand the prescribing patterns and clinical practices of providers for infants and children with bronchopulmonary dysplasia (BPD) in the outpatient clinic setting. METHODS: We conducted a survey of BPD Collaborative programs from diverse geographic areas inside and outside the United States from January 2025 through March 2025. RESULTS: Twenty-nine of 45 centers in the BPD Collaborative completed the survey, including 27 from the U.S. and 2 from other countries. The majority of respondents identified as pediatric pulmonologists (72.4%). Most healthcare providers endorsed that patient symptomatology was a major driver of decision making (79.3%) and greater BPD severity correlated with a higher likelihood of medication use. Beta-agonists and inhaled corticosteroids (ICS) were the most commonly prescribed medications across all levels of severity. While prescriptions for pulmonary hypertension (PH) medications and diuretics decreased with age, use of inhaled medications persisted or increased in frequency. Challenges obtaining medications included insurance authorization issues (69.0%) and medication costs (51.7%). Adherence to therapy was a concern for over half of BPD programs. CONCLUSIONS: Despite limited evidence for outpatient pharmacotherapy in children with BPD, we identified consistent cross-center practice patterns. Providers reported that while the utilization of therapies was associated with higher BPD severity and greater respiratory support, medications were prescribed across the spectrum of disease severity. Treatment practices varied by age group and were often hindered by common barriers to accessing medications. These findings underscore the need to revise clinical guidelines to enhance long-term outpatient pharmacotherapy for infants and children with BPD.

  PublisherDOI

• Effect modification of late surfactant treatment by patent ductus arteriosus status in ventilated preterm infants: a secondary analysis of a randomized clinical trial

  Journal of Perinatology · 2026-04-20

  articleOpen access

  OBJECTIVE: To evaluate whether the effect of late surfactant is modified by patent ductus arteriosus (PDA) status with respect to survival without bronchopulmonary dysplasia (BPD) in ventilated infants born <28 weeks' gestation. METHODS: Secondary analysis of the Trial of Late Surfactant (TOLSURF). A formal test of interaction between PDA presence and late surfactant, with respect to survival without BPD at 36 and 40 weeks' postmenstrual age (PMA), was performed. PDA presence was defined by PDA treatment, either medical or a ligation (definition A), or PDA ligation (definition B), during or after late surfactant administration. RESULTS: All 511 infants were included. No interaction was detected between a PDA and late surfactant for survival without BPD at 36 weeks' PMA (definition A: p = 0.41; definition B: p = 0.33), or at 40 weeks' PMA (definition A: p = 0.84; definition B: p = 0.42). CONCLUSION: PDA presence did not modify the effect of late surfactant for survival without BPD.

  PublisherOA PDFDOI

• What is the Role of Diuretics in the Prevention and Management of Bronchopulmonary Dysplasia?

  Current Treatment Options in Pediatrics · 2026-02-07 · 1 citations

  articleOpen accessSenior author

  Purpose of review: This review critically examines the role of furosemide and chlorothiazide in the prevention and management of bronchopulmonary dysplasia (BPD). We describe their common use, pharmacotherapeutic mechanisms, and summarize evidence from clinical trials and cohort studies evaluating their effects on diuresis and respiratory outcomes. Recent findings: Most evidence comes from studies in the 1980s that generalize poorly to contemporary neonatal care. However, a trial in 80 extremely preterm infants was published in 2025, reporting no certain effect of furosemide on death or BPD or on adverse effects other than electrolyte imbalances. The trial was not designed to address BPD prevention. Two recent large observational studies reported associations between greater diuretic exposure and lower risk of death or BPD but are limited by potential confounding. Earlier trials suggest diuretics may offer short-term improvements in urine output, pulmonary mechanics and gas exchange. Summary: The role of diuretics in the prevention and management of BPD remains uncertain. While transient, modest improvements in diuresis and respiratory function are likely, existing evidence does not convincingly support either clinically meaningful benefit or harm. In the absence of robust evidence-based guidance, minimizing routine diuretic use and considering short-term, selective treatment with measurable individualized goals is prudent. Addressing the disconnect between widespread use and limited supporting evidence will require well-designed studies that consider optimal patient selection, timing, dosing and duration in the context of current diuretic practice patterns.

  PublisherOA PDFDOI

• Changes in Diuretic Response to Furosemide During Postnatal Maturation in Very Preterm Infants

  American Journal of Respiratory and Critical Care Medicine · 2025-05-01

  article1st authorCorresponding

  Abstract Rationale: Furosemide is prescribed in preterm lung disease to promote diuresis and reduce edema. Pharmacokinetic (PK) data suggest that furosemide clearance increases with postnatal maturation, likely due to the upregulation of renal organic anion transporters (OAT), which enhance furosemide elimination through tubular secretion. This facilitates diuresis by delivering furosemide to the Na-K-Cl co-transporter within the urinary lumen, where it inhibits electrolyte reabsorption. The impact of postnatal development on the diuretic response to furosemide in very preterm (VP) infants remains unreported. Objective: To test the hypotheses that furosemide's maximal diuretic effect increases, while its duration of action decreases, with advancing postmenstrual age (PMA). Methods: We conducted an observational study in VP infants with bronchopulmonary dysplasia admitted between 2010-2023 using longitudinal EHR data from Children's Hospital of Philadelphia. We included furosemide exposures occurring after &amp;gt;7d without preceding use. The primary predictor, PMA, was grouped as ≤32, 33-39, ≥40 weeks based on prior PK data. Net fluid balance (NFB, intake – output) was measured for 24h before furosemide to calculate a baseline, and longitudinally after furosemide administration for 24h or until the next dose. Exposures with a &amp;gt;10% decrease in NFB relative to baseline were defined as responsive. Among these, maximal diuretic effect was defined as the greatest change in NFB relative to baseline in the 12h after furosemide, and duration of action as the time until NFB returned to &amp;lt;10% of baseline. Multivariable linear regression with cluster robust variance estimates assessed the associations between PMA and maximal diuretic effect and duration of action, adjusting for dosage characteristics (a priori) and clinical characteristics associated with the outcomes (p &amp;lt; 0.10 in bivariable analyses). Results: We identified 871 furosemide exposures among 441 VP infants. A response was observed in 800 exposures (92%). The adjusted mean maximal diuretic effect increased in each older PMA group, more than doubling at ≥40 vs ≤32 weeks PMA: 9.3(8.4-10.1) vs 4.3(3.2-5.4) ml/kg/h, p &amp;lt;0.001. Duration of action shortened with increasing PMA, falling from 13.3(12.1-14.5) at ≤32 to 10.0(9.5-10.5) hours at ≥40 weeks PMA, p&amp;lt;0.001 (Table). Conclusion: The diuretic response to furosemide changes across postnatal maturation in VP infants. This developmentally graded response has clinical implications regarding dosage adjustments as VP infants mature. Further, these observations suggest a dynamic maturational window for OAT expression in VP infants, with broad developmental pharmacology implications for medications relying on this transporter for elimination.

  PublisherDOI

• Association between route of furosemide administration and diuretic response in very preterm infants with bronchopulmonary dysplasia

  Journal of Perinatology · 2025-12-01

  preprintOpen access1st authorCorresponding

  OBJECTIVE: Furosemide is commonly prescribed in hospitalized infants with grade 2-3 bronchopulmonary dysplasia (BPD). Intravenous (IV), gastric, and duodenal administrations are common, with a 1:2 IV-to-enteral conversion often used despite uncertain bioavailability. Our objective was to compare diuretic responses between routes in infants with BPD. STUDY DESIGN: Single-center observational cohort of very preterm infants with grade 2-3 BPD prescribed furosemide. The association between route (exposure) and diuretic response (change in net fluid balance after administration, outcome) was evaluated using multivariable regression adjusting for dosing and infant characteristics. RESULTS: Among 153 infants (median postmenstrual age of 43.3 weeks at exposure), furosemide reduced fluid balance by -25.6 (29.8) ml/kg/d. Adjusted mean changes were similar across routes: IV, -25.3 (-35.8, -14.7), gastric, -25.8 (-32.2, -19.4), and duodenal, -25.8 (-34.2, -17.4). CONCLUSIONS: Our data suggest a 1:2 IV-to-enteral conversion leads to comparable diuretic effects in infants with established BPD, supporting this common clinical practice.

  PublisherOA PDFDOI

• Chlorothiazide Is Associated with a Weaker Diuretic Response than Furosemide in Infants with Bronchopulmonary Dysplasia

  American Journal of Perinatology · 2025-10-03

  articleOpen accessSenior author

  Objective: This study aimed to compare the acute diuretic effect of furosemide versus chlorothiazide in preterm infants with high-grade bronchopulmonary dysplasia (BPD). Study Design: We conducted a retrospective cohort study of infants with grade 2 or 3 BPD admitted to a level IV NICU between 36 and 60 weeks postmenstrual age. Novel diuretic exposures were defined as administration of furosemide or chlorothiazide without prior exposure to the same agent in the preceding 7 days. The primary outcome was the within-subject change in net fluid balance (mL/kg) in the 24 hours before and after diuretic initiation. Multivariable linear regression was performed adjusted for diuretic dosing, route, frequency, and clinical covariates. Results: = 0.032). Concomitant use of both agents was common, yet the order of administration did not significantly influence fluid balance. No other clinical or biochemical characteristics were significantly associated with diuretic response. Conclusion: Furosemide has a significantly greater acute diuretic effect than chlorothiazide in infants with high-grade BPD. These findings may inform short-term fluid management strategies and support further investigation into optimal diuretic selection and dosing in this population. Key Points: · Furosemide has a greater acute diuretic effect than chlorothiazide in infants with grade 2/3 BPD.. · More frequent dosing was associated with greater diuretic effect than daily dosing for both agents.. · Concomitant use of both agents was common; the order of administration did not impact fluid balance..

  PublisherOA PDFDOI

• Association between the respiratory severity score and extubation success in severe bronchopulmonary dysplasia

  Journal of Perinatology · 2025-08-21

  articleSenior author
  PublisherDOI

• Pulmonary vasodilator use in very preterm infants in United States children’s hospitals

  Journal of Perinatology · 2025-05-02 · 1 citations

  articleOpen accessSenior author

  OBJECTIVES: To describe common pulmonary vasodilators (PV), exposure timing, and characteristics associated with their use in very preterm (VP) infants. STUDY DESIGN: Observational study of VP infants discharged from U.S. children's hospitals (2011-2021). PV exposures during hospitalization were identified, and multivariable modeling determined characteristics associated with exposure. RESULTS: Among 37,428 infants, 6.3% received PV. Early inhaled nitric oxide (iNO) and late sildenafil were most common. Early exposure was associated with lower gestational age, aOR: 9.2 (7.3-11.7), 22-25 vs. 29-31 weeks) and small for gestational age (SGA), 2.3 (2.0-2.7). Late exposure was associated with bronchopulmonary dysplasia (BPD) grade, 26.2 (16.8-40.9), grade 3 vs. no BPD) and early PV exposure, 3.7 (2.9-4.8). CONCLUSIONS: Early iNO and late sildenafil are used in VP infants despite limited evidence. Prospective early studies enrolling extremely preterm and SGA infants and late studies enrolling infants with early PV exposure and high-grade BPD would target current evidence gaps.

  PublisherOA PDFDOI

• Clinician knowledge, attitudes, and perceptions of delirium in patients with grade 3 bronchopulmonary dysplasia: A national survey

  Journal of Perinatology · 2025-12-19

  article
  PublisherDOI

• Characteristics associated with death or tracheostomy in infants with bronchopulmonary dysplasia following predominant non-invasive respiratory support

  Journal of Perinatology · 2025-02-21 · 1 citations

  articleSenior author
  PublisherDOI

Recent grants

• Furosemide in severe bronchopulmonary dysplasia: comparative effectiveness of a duration and dosage informed treatment strategy

  NIH · $792k · 2020–2025

Frequent coauthors

• Haresh Kirpalani

  Eunice Kennedy Shriver National Institute of Child Health and Human Development

  44 shared

• Erik A. Jensen

  University of Pennsylvania

  40 shared

• Sara B. DeMauro

  Children's Hospital of Philadelphia

  38 shared

• Kathleen Gibbs

  Nationwide Children's Hospital

  22 shared

• Ravi M. Patel

  Eunice Kennedy Shriver National Institute of Child Health and Human Development

  21 shared

• Scott A. Lorch

  21 shared

• Eric C. Eichenwald

  Eunice Kennedy Shriver National Institute of Child Health and Human Development

  20 shared

• Timothy D. Nelin

  Children's Hospital of Philadelphia

  13 shared

Education

• MSCE, Center for Clinical Epidemiology and Biostatistics

  University of Pennsylvania Perelman School of Medicine

  2017

• MD

  University of Pennsylvania School of Medicine

  2010