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

Shin Kato1, Masato Koizumi2, Jun Nirei3

  • 1Department of Pediatrics, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan, shinkato2@gmail.com.

Neonatology
|July 9, 2026
PubMed

Insights

Diuretics do not prevent bronchopulmonary dysplasia (BPD) in preterm infants, according to current evidence. More research is needed to confirm their role and safety in BPD prevention strategies.

Area of Science:

  • Neonatal Medicine
  • Pediatric Pulmonology
  • Pharmacology

Background:

  • Bronchopulmonary dysplasia (BPD) remains a significant challenge in preterm infant care.
  • Previous randomized controlled trials (RCTs) have not established the efficacy of diuretics in preventing BPD.
  • Recent observational studies suggest a potential role for diuretics, necessitating an updated synthesis of evidence.

Purpose of the Study:

  • To evaluate the preventive effects of diuretics on bronchopulmonary dysplasia (BPD) in preterm infants.
  • To assess the safety profile of diuretic use in this vulnerable population.
  • To synthesize evidence from both randomized and non-randomized studies.

Main Methods:

  • Comprehensive literature search of MEDLINE, Embase, Cochrane CENTRAL, and CINAHL up to June 2025.
  • Inclusion of 40 studies (6 RCTs, 34 non-randomized studies) evaluating various diuretic classes, routes, doses, and durations.
  • Risk of bias assessment using RoB 2 and ROBINS-I; certainty of evidence graded by GRADE; meta-analysis using random-effects models.

Main Results:

  • RCTs did not demonstrate a preventive effect of diuretics on BPD, focusing mainly on short-term lung mechanics.
  • Meta-analysis revealed 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); however, non-randomized studies suggested potential BPD reduction, but with low to very low certainty of evidence.

Conclusions:

  • Current evidence does not confirm that diuretics prevent bronchopulmonary dysplasia (BPD).
  • The safety profile of diuretics appears favorable, but evidence quality is limited by small sample sizes and confounding factors.
  • Larger, adequately powered RCTs are essential to definitively explore the role of diuretics in BPD prevention.
Abstract

Keywords:
Bronchopulmonary dysplasiaDiureticsFurosemideMeta-analysisPreterm infantsRandomized controlled trialsSystematic review

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