Association between chronic diuretics and postnatal growth in preterm infants with bronchopulmonary dysplasia

Background: Chronic diuretics such as thiazides and spironolactone are frequently used off-label in preterm infants with evolving or established bronchopulmonary dysplasia (BPD). Infants who are high risk for BPD are already predisposed to poor postnatal growth and the effect of chronic diuretics on postnatal growth is not well studied. Objective: Exploratory study to determine the association between chronic diuretic exposure and short-term postnatal growth in preterm infants born at less than ≤ 29 weeks gestational age (GA). Methods: Single-center retrospective cohort study in a level IV neonatal intensive care unit over a 2-year period (2021–22). Eligible infants exposed to chronic diuretics > 5 days for BPD (diuretic group) were compared to infants who were not (non-diuretic group). Results: In total, 53 infants (19 diuretic, and 35 non-diuretic group) were identified. The GA (25.3 vs 27.0 weeks) and birth weight (780 vs. 995 gs) were significantly lower in diuretic vs. non-diuretic group (p = 0.01). Diuretic group had higher intubation rate at birth, more days on non-invasive ventilation, higher incidence of moderate/severe BPD, and longer hospital stay (all p < 0.05). The GA adjusted z-scores for weight, length, and head circumference at birth, at 36-week corrected GA, and at discharge were similar in both groups. Also, the z-score change from birth at 36-week corrected GA, and at discharge were similar in both groups. There was no significant short-term change in weight z-score in the 2 weeks following chronic diuretic exposure. Conclusions: Chronic diuretic exposure has no significant association with short-term postnatal growth in preterm infants.