Diuretics for Preventing Bronchopulmonary Dysplasia in Preterm Infants: A Systematic Review and Meta-Analysis

Randomized controlled trials (RCTs) have not demonstrated that diuretics prevent bronchopulmonary dysplasia (BPD), but recent observational studies warrant an updated synthesis. We evaluated the preventive effects and safety of diuretics in preterm infants at risk of developing BPD.

MEDLINE, Embase, Cochrane CENTRAL, and CINAHL were searched through June 2025. We included randomized and non-randomized studies of various diuretic classes with different routes, dosing regimens, and treatment durations. The risk of bias was assessed using the RoB 2 and ROBINS-I, and the certainty of evidence using GRADE. Random-effects models were used to calculate the risk ratios and 95% confidence intervals.

Forty studies, including six randomized controlled trials (RCTs), were analyzed. Furosemide was the most frequently used diuretic. The RCTs predominantly focused on short-term changes in lung mechanics and did not demonstrate any preventive effect of diuretics on BPD. The meta-analysis showed no significant effects of diuretics on death or BPD (RR, 1.10; 95% CI, 0.77-1.59) or mortality (RR, 0.44; 95% CI, 0.19-1.04). Electrolyte abnormalities were not significantly increased (RR, 1.51; 95% CI, 0.81-2.83). Non-randomized studies have reported a potential reduction in BPD occurrence. However, the overall certainty of the evidence is low to very low due to the small sample sizes and confounding.

The current evidence does not confirm that diuretics prevent BPD. Given the uncertainty of the current evidence and the favorable safety profiles, adequately powered RCTs are needed to explore the potential role of diuretics in BPD prevention.