This retrospective cohort study examined whether outpatient diuretic use affects somatic growth (weight z-scores) in 829 infants with BPD (born ≤32 weeks gestation) seen at two tertiary BPD clinics between 2008–2023, comparing weight z-scores before and after diuretic discontinuation (median age ~9.23 months) between diuretic-treated (n=459) and untreated (n=370) groups.
After adjusting for gestational age, birth weight, BPD severity, pulmonary hypertension, and gastrostomy tube, outpatient diuretic use was **not** associated with a significant difference in weight z-scores before or after discontinuation. Children not on diuretics had a greater improvement in weight z-score (0.97 vs. 0.64, p<0.001), but this difference disappeared on adjusted, site-clustered analysis.
- Retrospective design with no granular data on diuretic dose, duration, or adherence; discharge weight z-scores were unavailable, limiting trajectory analysis during active diuretic exposure. - Detailed nutritional data (caloric density, fortification) not captured — residual confounding by nutrition possible. - Cohort drawn from two tertiary BPD centers enriched for severe disease, limiting generalizability to milder BPD; 15-year enrollment window introduces risk of temporal confounding from evolving care practices.
Outpatient diuretic therapy does not appear to impair weight gain in infants with BPD — clinicians need not discontinue diuretics based on growth concerns alone. An individualized approach guided by respiratory status, with close weight monitoring and gradual weaning as the child outgrows the dose, remains reasonable practice.
