Special Nutritional Needs of Infants for Prevention of and Recovery from Bronchopulmonary Dysplasia

Abstract

Extremely low birth weight infants who develop severe respiratory disease may have special nutrient requirements imposed by a combination of enhanced utilization of nutrients or the need for epithelial cell repair resulting from the disease process, as well as to support catch-up growth. Inositol, free fatty acids, vitamin E and vitamin A are proposed as nutrients for which infants at risk of chronic pulmonary insufficiency may have special requirements. Of these nutrients, only for vitamin A does suggestive evidence exist that high doses when given intramuscularly may reduce the incidence of death or chronic lung disease. Exogenous steroid therapy (dexamethasone), which is often used to improve pulmonary compliance in ventilated premature infants, may compromise vitamin A status and induce restricted somatic and bone mineral growth. Supplemental nutrition by means of enriched infant formulas has provided benefits in growth and bone mass accretion to infants recovering from bronchopulmonary dysplasia up to 3-mo corrected age. This growth advantage was not sustained over the subsequent 9 mo, suggesting that prolonged nutritional support is required until catch-up growth is complete. Further studies are required to delineate the needs for specific nutrients such as antioxidant vitamins and minerals or vitamin A that may play a role in preventing severe chronic lung disease in premature infants. As well, the role of supplemental nutrition (beyond the requirements of term infants) to support catch-up growth and maintenance during the critical stages of early development requires further investigation before evidence-based nutrient recommendations can be developed for this special population of infants.

A double-blind, randomized clinical trial of the effect of ω-3 fatty acids on the oxidative stress of preterm neonates fed through parenteral nutrition

“…Both vitamins are regarded as important biological antioxidants and their supplementation in preterm neonates was documented many years ago (Orzalesi, 1987). Vitamin E supplementation has been implicated in the prevention of bronchopulmonary dysplasia and elevations in hemoglobin levels in preterm neonates (Petrich et al, 1976), while vitamin A has been shown to prevent chronic lung disease, bronchopulmonary dysplasia and sepsis (Tyson et al, 1999;Atkinson, 2001;Darlow and Graham, 2007). In this study, both groups were supplemented with the same dose of fatsoluble vitamins.…”

Sagittal Distraction of the Sternum in a Juvenile Male with Severe Short Rib Syndrome and Thoracic Insufficiency Syndrome - A Case Report

“…In severe respiratory insufficiency, even oral nutritional intake may represent a challenge because the patient may not tolerate the small breathing pause due to eating [18][19][20]. Our patient was described as having major difficulties in gaining weight all his life and had suffered from a poor appetite for years due to abdominal pain immediately after oral food intake, which worsened his nutritional status.…”

Comparison of resting energy expenditure in bronchopulmonary dysplasia to predicted equation

“…Good nutrition is essential in these chronically ill infants (Schols et al, 1991). In the neonatal period, although the daily energy requirement of a given patient is based on the estimated REE, it is often necessary to restrict the daily fluid intake to 100-120 ml/kg/day (Atkinson, 2001). This avoids the development of pulmonary congestion or edema (Filippone et al, 2003).…”

“…Children with chronic lung disease of prematurity present malnutrition with a decrease in FM and in low metabolic FFM (Goran et al, 1994;Ashley et al, 2001;Atkinson, 2001;Fok et al, 2001). REE, for these reasons, prediction equation should be precisely correlated with age in the population with BPD.…”