The article by Venkataraman et al (see p 1157) in this issue of the AJDC calls attention to another of the hazards of furosemide therapy for infants with bronchopulmonary dysplasia (BPD). Venkataraman and colleagues are not the first investigators to do so,1 but their observations extend our knowledge of the danger of this therapy.
Bronchopulmonary dysplasia is a disorder of increasing incidence because treatment modalities of the past two decades have increased survival in low-birth-weight infants. While the causal chain is not completely understood, oxygen therapy and the prolonged use of ventilators show a strong association.2 The pathophysiology of BPD includes interstitial pulmonary edema. Is furosemide rational therapy for this disturbance? If so, do the risks outweigh the benefits? The succeeding paragraphs comment on these two questions and lead to some surprising observations.
The primary use of furosemide in medicine is as a potent "loop" diuretic. Its mechanism