Nutritional strategies and growth in extremely low birth weight infants with bronchopulmonary dysplasia over the past 10 years

Abstract

Objective: Changes in nutritional strategies over the past decade have been shown to improve postnatal growth in extremely low birth weight (ELBW) infants. We showed 10 years ago that the majority of these ELBW infants with bronchopulmonary dysplasia (BPD) suffer postnatal growth failure. We theorized that recent changes in nutritional support strategies would positively affect growth outcomes in ELBW infants with BPD.Study Design: A retrospective study of 88 ELBW infants with BPD. Nutritional data, postnatal growth and BPD severity were compared across three cohorts: (1) weight gain p14 g kg À1 per day, (2) 14.1 to 16 g kg À1 per day and (3) X16 g kg À1 per day from return to birth weight through discharge. We also compared these to a historical cohort.Result: In all, 73% of current subjects grew at or above fetal rates. There was less extrauterine growth restriction (EUGR) by weight and head circumference for those ELBW infants with BPD receiving higher amounts of protein. Aggressive early TPN and receipt of caloric-dense milk seemed to be the 'new' nutritional strategies improving growth for current ELBW infants with BPD compared with those 10 years ago.Conclusion: Despite a diagnosis of BPD, improved nutritional strategies have enhanced postnatal growth in infants at high risk for EUGR.

The role of nutrition in promoting growth in pre-term infants with bronchopulmonary dysplasia: a prospective non-randomised interventional cohort study

“…Our results are consistent with previously published data [19, 20] indicating that improved nutritional strategies can positively affect the growth of pre-term infants with BPD, who frequently suffer from post-natal growth retardation [6, 21]. Madden et al [19] found a significant increase in mean weight z-scores and a decrease in the proportion of infants with a mean weight z-score of <2 SD at 20 months of corrected age in a cohort of extremely low gestational age infants with BPD born in 2000-2003 in comparison with a cohort of extremely low gestational age infants with BPD born in 1996-1999.…”

“…The authors speculated that the improvement in the growth outcomes may have been due to changes in the infants’ nutritional management, such as the use of more aggressive parenteral nutrition and more caloric post-discharge formulae. Theile et al [20] retrospectively studied 88 extremely low birth weight infants with BPD, and found a reduction in post-natal growth retardation at the time of hospital discharge (as assessed on the basis of weight and head circumference) in infants fed caloric-dense milk. However, as we found that the improved weight gain in the infants belonging to the intervention group was not associated with an improvement in length gain, there may be some concern about the quality of their growth because, although accompanied by the provision of a sufficient protein intake, the increased caloric intake may have caused relatively greater fat deposition [22].…”

Impaired Growth at Birth and Bronchopulmonary Dysplasia Classification: Beyond Small for Gestational Age

“…[19][20][21][22] However, in our cohort there were no overall growth differences at 36 weeks PMA between infants with no/mild BPD and infants with moderate/severe BPD. In the infants born < 26 weeks GA who developed moderate/severe BPD, we observed that length and head circumference growth lagged behind the infants who had no/mild BPD.…”

The Clinical Application of Proteomics and Metabolomics in Neonatal Medicine

“…In addition, they tried to verify if increased rates of protein administration during the first month of life could achieve higher growth rates, as has been suggested previously (52). The literature is at significant variance here, in that earlier and subsequent trials have shown that both positive effects upon growth and no effects when protein/amino acid supplementation have been increased (53). In addition, certain amino acids and amino acid acylcarnitines (e.g., isovalerylcarnitine) were elevated to levels that were of concern, while other amino acid levels (e.g., alanine) appeared to be inadequate.…”