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This symposium on chronic lung disease of prematurity (CLD) by Kotecha et al1 covered important aspects and controversies in the management of CLD. We accept the authors’ inability to cover all aspects of management. We feel that some space could have been devoted to diuretics in management of CLD. Nearly all patients with CLD of some stage of their disease will receive diuretics and most of them will be on them for a long time. We came across only one systemic review by Brion et al2 in the Cochrane database. Conclusion of the authors was that there was no beneficial effect of using distal tubular diuretics for more than 4 weeks after initial stage. There was also no benefit in adding potassium sparing diuretics or newer diuretics like metalozone. Inspite of very little evidence base for diuretics in CLD, one finds nearly all CLD patients on a diuretic cocktail. In addition to their effect on electrolytes, they affect Ca/PO4 metabolism. This may exacrebate osteopenia of prematurity and may have adverse effect on lung compliance. There is a need for more discussion or clear guidelines on this issue.
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