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. 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. 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.

Abstract Purpose of review Bronchopulmonary dysplasia (BPD) remains a very common complication of extreme prematurity and has significant adverse long-term consequences. Specific treatments to prevent the development of BPD or to treat established BPD are very limited. We have reviewed recent advances in the management of preterm-born infants at risk of developing BPD and in those with established BPD as well as potential future emerging treatment options. Recent findings Strategies to prevent iatrogenic lung trauma, such as non-invasive respiratory support and administration of exogeneous surfactant in a less invasive manner have now become embedded in clinical practice, but further studies are ongoing with the POLAR and SURFSUP trials aiming to refine these interventions. Strategies, other than postnatal systemic corticosteroids, to suppress lung inflammation have also been evaluated. However, both the early use of azithromycin and administration of endotracheal budesonide mixed with exogenous surfactant have not shown benefits for survival without development of BPD. Later in life, survivors of BPD at school-age show significant improvement in lung function with combined inhaled corticosteroids and long-acting beta 2 adrenoreceptor agonists, but therapeutic options to improve long term lung function are urgently required. Summary Further detailed understanding of the underlying mechanisms for the development of BPD are required so targeted treatments can be developed.