Growth and body composition in preterm infants with bronchopulmonary dysplasia

Abstract

Objective: To compare growth and body composition in preterm infants with bronchopulmonary dysplasia (BPD) with normal healthy term infants during the first year of life. Design: Twenty nine preterm infants with BPD (mean (SD) gestational age 27.1 (1.6) weeks; birth weight 852 (173) g) were followed prospectively. Anthropometry and body composition determined by total body electrical conductivity were measured and compared with those of healthy term infants at the same post-term age. Results: In infants with BPD, the mean weight standard deviation scores (SD scores) 6 weeks after term were significantly lower (−1.44 and −2.68, boys and girls respectively) than in healthy term infants of the same age and did not improve during the first year. The mean length SD score was significantly lower in infants with BPD 6 weeks after term than in healthy term infants of the same age, and, although it improved significantly during the first year, the mean length SD score in girls with BPD was significantly below 0 12 months after term. In infants with BPD, the mean free fat mass (FFM) SD score and the mean total body fat (TBF) SD score at 6 weeks post-term age were significantly below 0. The mean FFM SD scores (−1.01 and −2.56, boys and girls respectively) and the mean TBF SD scores (−1.14 and −2.40, boys and girls respectively) 12 months after term were significantly lower than in healthy term infants of the same age. Conclusions: Preterm infants with BPD have impaired growth, with a deficit in TBF and FFM already 6 weeks after term; FFM and TBF remain low compared with healthy term infants during the first year of life. Nutritional intervention studies in infants with BPD are needed to evaluate if nutrition is the major determinant of growth and body composition or if this pattern of growth in preterm infants with BPD is the result of disturbed endocrine control. P reterm infants who develop bronchopulmonary dysplasia (BPD) show impaired growth during early infancy compared with term 1 2 and preterm 3 infants who do not. The impaired growth sometimes extends over the first few years of life.4 Different explanations for the slow growth in infants with BPD have been proposed, such as the increased work required to breathe, early use of corticosteroids, intrauterine growth retardation, early postnatal growth retardation, 5 6 and feeding problems related to inadequate intake or high metabolic rate.

Crescimento e desenvolvimento a longo prazo do prematuro extremo

“…[27][28] A recent study of ELW preterms with bronchopulmonary dysplasia, recorded that, during their first year of life, they exhibited growth deficiency with no catch-up in weight and abnormal body composition, with reduced lean and fat mass content. 29 A wide-ranging, multicenter study assessing the effects of bronchopulmonary dysplasia on long term growth, involving very low weight premature children assessed at 8-10 years of age, found lower weight and head circumference among children who had had dysplasia. However, when confounding variables were controlled (gestational age, birth weight, postnatal disease, neurological sequelae and sociodemographic factors) differences in growth disappeared, suggesting that the inadequate growth of children with bronchopulmonary dysplasia could be associated with a number of other factors and not necessarily the disease itself.…”

Early Life Factors Predict Abnormal Growth and Bone Accretion at Prepuberty in Former Premature Infants With/Without Neonatal Dexamethasone Exposure

“…DEX therapy is associated with growth restriction in infants (5). Preterm BPD infants who were treated with DEX demonstrated impaired growth, with a lower whole body fat and lean mass than healthy term infants during the first year of life (6). Compared with nonsteroid-treated VLBW control infants, the VLBW infants treated with DEX for BPD also showed lower weight and shrinkage of the lower leg length (7).…”

Osmolality of preterm formulas supplemented with nonprotein energy supplements

“…The analyzed non-supplemented preterm formulas contain between 71 and 81 kcal/100 ml, providing daily mean energy intakes between 107 and 122 kcal/kg with fluid intake of 150 ml/kg/day, but only 92.5-105.7 kcal/kg if fluid intake is restricted to 130 ml/kg/day. This suboptimal energy intake is a major factor contributing to growth impairment and alterations in body composition in infants with BPD (Kurzner et al, 1988;Tammela et al, 1992;Huysman et al, 2003). About 82-91 kcal/100 ml may be necessary for lung repair and adequate growth in infants with BPD, but approximately 98 kcal/100 ml may be needed when fluid intake is restricted to p130 ml/kg/day (Puangco and Schanler, 2000).…”