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Miller AN, Curtiss J, Kielt MJ. Nutritional Needs of the Infant with Bronchopulmonary Dysplasia. Neoreviews 2024; 25:e12-e24. [PMID: 38161180 DOI: 10.1542/neo.25-1-e12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
Growth failure is a common problem in infants with established bronchopulmonary dysplasia (BPD). Suboptimal growth for infants with BPD is associated with unfavorable respiratory and neurodevelopmental outcomes; however, high-quality evidence to support best nutritional practices are limited for this vulnerable patient population. Consequently, there exists a wide variation in the provision of nutritional care and monitoring of growth for infants with BPD. Other neonatal populations at risk for growth failure, such as infants with congenital heart disease, have demonstrated improved growth outcomes with the creation and compliance of clinical protocols to guide nutritional management. Developing clinical protocols to guide nutritional management for infants with BPD may similarly improve long-term outcomes. Given the absence of high-quality trials to guide nutritional practice in infants with BPD, the best available evidence of systematic reviews and clinical recommendations can be applied to optimize growth and decrease variation in the care of these infants.
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Affiliation(s)
- Audrey N Miller
- Comprehensive Center for Bronchopulmonary Dysplasia, Nationwide Children's Hospital and Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH
| | - Jennifer Curtiss
- Department of Clinical Nutrition and Lactation, Nationwide Children's Hospital, Columbus, OH
| | - Matthew J Kielt
- Comprehensive Center for Bronchopulmonary Dysplasia, Nationwide Children's Hospital and Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH
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Nutrition of Infants with Bronchopulmonary Dysplasia before and after Discharge from the Neonatal Intensive Care Unit. Nutrients 2022; 14:nu14163311. [PMID: 36014815 PMCID: PMC9414083 DOI: 10.3390/nu14163311] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/05/2022] [Accepted: 08/08/2022] [Indexed: 11/21/2022] Open
Abstract
Bronchopulmonary dysplasia (BPD) represents a severe sequela in neonates born very prematurely. The provision of adequate nutritional support in this high-risk population is challenging. The development of the lungs and physical growth are closely linked together in infants with BPD. Growth deficiency has been associated with pulmonary dysfunction, whereas improvement in respiratory status results in growth acceleration. Currently, there is not enough data regarding optimal nutritional strategies in this population. Nutrition in these infants should provide sufficient calories and nutrients to establish growth, avoid growth retardation and assist alveolarization of the lungs. Meticulous follow-up is mandatory during and after discharge from the Neonatal Intensive care Unit (NICU) to minimize growth retardation and improve lung function. Despite the significant literature supporting the contribution of growth and nutrition in the avoidance of BPD, there is limited research regarding interventions and management of infants with established BPD. Our aim was to review clinical strategies applied in everyday clinical practice and identify debates on the nutritional approach of newborns with BPD. Well-organized interventions and clinical trials regarding the somatic development and nutrition of infants with BPD are warranted.
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Bauer SE, Huff KA, Vanderpool CPB, Rose RS, Cristea AI. Growth and nutrition in children with established bronchopulmonary dysplasia: A review of the literature. Nutr Clin Pract 2022; 37:282-298. [DOI: 10.1002/ncp.10841] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 12/01/2021] [Accepted: 12/26/2021] [Indexed: 12/25/2022] Open
Affiliation(s)
- Sarah E. Bauer
- Department of Pediatrics Indiana University Indianapolis Indiana USA
| | - Katie A. Huff
- Department of Pediatrics Indiana University Indianapolis Indiana USA
| | | | - Rebecca S. Rose
- Department of Pediatrics Indiana University Indianapolis Indiana USA
| | - A. Ioana Cristea
- Department of Pediatrics Indiana University Indianapolis Indiana USA
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Bauer SE, Vanderpool CPB, Ren C, Cristea AI. Nutrition and growth in infants with established bronchopulmonary dysplasia. Pediatr Pulmonol 2021; 56:3557-3562. [PMID: 34415681 DOI: 10.1002/ppul.25638] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 07/06/2021] [Accepted: 08/17/2021] [Indexed: 12/23/2022]
Abstract
Bronchopulmonary dysplasia (BPD) remains the most common late morbidity of preterm birth. Ongoing clinical care and research have largely focused on the pathogenesis and prevention of BPD in preterm infants. However, preterm infants who develop BPD have significant medical needs that persist throughout their neonatal intensive care unit course and continue post-discharge, including those associated with growth and nutrition. The objective of this manuscript was to provide a review on nutrition and growth in infants with established BPD after discharge from the hospital and to identify the knowledge and research gaps to provide direction for future studies.
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Affiliation(s)
- Sarah E Bauer
- Department of Pediatrics, Indiana University, Indianapolis, Indiana, USA
| | | | - Clement Ren
- Division of Pulmonary and Sleep Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Aura Ioana Cristea
- Department of Pediatrics, Indiana University, Indianapolis, Indiana, USA
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5
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Growth in children with congenital diaphragmatic hernia during the first year of life. J Pediatr Surg 2014; 49:1363-6. [PMID: 25148738 DOI: 10.1016/j.jpedsurg.2014.02.081] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 01/06/2014] [Accepted: 02/12/2014] [Indexed: 11/20/2022]
Abstract
PURPOSE Infants with congenital diaphragmatic hernia (CDH) have high rates of mortality and long-term morbidity, including poor growth and failure to thrive. The aim of this study was to describe growth patterns during the first year of life in infants with congenital diaphragmatic hernia in a non-ECMO cohort. METHODS Medical records of infants with CDH admitted to our center between January 2005 and December 2011 were reviewed. Infants with anthropometric measurements at 3, 6 and 12months were included. Anthropometric measurements were obtained for the first year of life. Logistic regression analyses were performed to find predictive associations with failure to thrive (FTT). RESULT Of the 45 survivors, 38 were seen twice (84%) and 24 (53%) were seen on three occasions to age 12months. Poor growth was observed with weight being most affected. FTT was present in 63% during the first six months of life. Days of mechanical ventilation were the only predictor of FTT. Besides poor weight gain, height and head circumference were also reduced. However, catch-up growth occurred during the second half of infancy and at age 12months failure to thrive had reduced by two thirds to 21%. CONCLUSIONS Poor growth is a common early finding in CDH patients, which improves during infancy. This emphasizes the importance of close follow-up and aggressive nutritional management in CDH patients.
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Enteral zinc supplementation and growth in extremely-low-birth-weight infants with chronic lung disease. J Pediatr Gastroenterol Nutr 2014; 58:183-7. [PMID: 24121149 PMCID: PMC4125018 DOI: 10.1097/mpg.0000000000000145] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Zinc deficiency causes growth deficits. Extremely-low-birth-weight (ELBW) infants with chronic lung disease (CLD), also known as bronchopulmonary dysplasia, experience growth failure and are at risk for zinc deficiency. We hypothesized that enteral zinc supplementation would increase weight gain and linear growth. METHODS A cohort of infants was examined retrospectively at a single center between January 2008 and December 2011. CLD was defined as the need for oxygen at 36 weeks postmenstrual age. Zinc supplementation was started in infants who had poor weight gain. Infants' weight gain and linear growth were compared before and after zinc supplementation using the paired t test. RESULTS A total of 52 ELBW infants with CLD met entry criteria. Mean birth weight was 682 ± 183 g, and gestational age was 25.3 ± 2 weeks. Zinc supplementation started at postmenstrual age 33 ± 2 weeks. Most infants received fortified human milk. Weight gain increased from 10.9 before supplementation to 19.9 g · kg(-1) · day(-1) after supplementation (P < 0.0001). Linear growth increased from 0.7 to 1.1 cm/week (P = 0.001). CONCLUSIONS Zinc supplementation improved growth in ELBW infants with CLD receiving human milk. Further investigation is warranted to reevaluate zinc requirements, markers, and balance.
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Abstract
We aimed to assess the current knowledge on the nutritional management of preterm infants at risk of developing bronchopulmonary dysplasia (BPD) or with BPD. We considered the evidence supporting the actual fluid and energy intake, proteins, lipids, and electrolytes requirement, and need for other nutrients in preterm infant at risk of developing BPD or with BPD. We concluded that, although many areas remain to be investigated, early nutrition support and careful adjustment of parenteral nutrition and appropriate enteral feeding selection may enhance the growth and contribute a better neurodevelopment in these patients.
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Affiliation(s)
- Carlo Dani
- Department of Surgical and Medical Critical Care, Section of Neonatology, Careggi University Hospital of Florence, Firenze, Italy.
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Zuloaga DG, Carbone DL, Handa RJ. Prenatal dexamethasone selectively decreases calretinin expression in the adult female lateral amygdala. Neurosci Lett 2012; 521:109-14. [PMID: 22668856 DOI: 10.1016/j.neulet.2012.05.058] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Revised: 04/06/2012] [Accepted: 05/18/2012] [Indexed: 01/07/2023]
Abstract
Exposure to high levels of glucocorticoids (GCs) during early development results in lasting disturbances in emotional behavior in rodents. Inhibitory GABAergic neurons, classified by their expression of calcium binding proteins (CBPs), also contribute to stress-related behaviors and may be GC sensitive during development. Therefore, in the present study we investigated the effects of prenatal treatment with the glucocorticoid receptor agonist dexamethasone (DEX) on expression of calbindin and calretinin in brain areas critical to emotional regulation (basolateral/lateral amygdala and hippocampal CA1 and CA3 regions). Late gestational treatment with DEX (gestational days 18-22) significantly decreased the density of calretinin immunoreactive cells in the lateral amygdala of adult female offspring with no differences in the basolateral amygdala, hippocampal CA1, or CA3 regions. Moreover, there were no effects of gestational DEX treatment on calretinin expression in males. Calbindin expression in adulthood was unaltered within either amygdala or hippocampal subregion of either sex following prenatal DEX treatment. Together these findings indicate that late gestational DEX treatment causes a targeted reduction of calretinin within the lateral amygdala of females and this may be one mechanism through which developmental glucocorticoid exposure contributes to lasting alterations in emotional behavior.
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Affiliation(s)
- Damian G Zuloaga
- Department of Basic Medical Sciences, University of Arizona College of Medicine, Phoenix, AZ 85004, United States.
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Wang LY, Luo HJ, Hsieh WS, Hsu CH, Hsu HC, Chen PS, Chiu NC, Lee WT, Jeng SF. Severity of bronchopulmonary dysplasia and increased risk of feeding desaturation and growth delay in very low birth weight preterm infants. Pediatr Pulmonol 2010; 45:165-73. [PMID: 20054861 DOI: 10.1002/ppul.21171] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Oral feeding has been reported to compromise breathing among preterm infants with bronchopulmonary dysplasia (BPD) during hospitalization or shortly after discharge. However, limited information was available concerning whether preterm infants with BPD remain vulnerable to feeding and growth insufficiency after a longer term of follow-up. The purpose of this study was therefore to examine the effect of severity of BPD on pulse oxygen saturation (SpO(2)) during feeding and growth in very low birth weight (VLBW) preterm infants during infancy. Seventy-two preterm infants with VLBW and 15 term infants were prospectively examined their growth and SpO(2) during feeding at 2, 4, and 6 months of corrected age. The severity of BPD was graded in VLBW infants according to the American National Institutes of Health consensus definition. In comparison to VLBW infants with mild BPD and term infants, VLBW infants with severe BPD showed significantly lower mean levels of SpO(2) during feeding at 2-6 months corrected age (P < 0.05). Those with severe BPD further exhibited higher rates of growth delay (weight < 10th percentile) throughout the study period. Among VLBW infants, severe BPD had an adverse relation with subsequent weight measures after adjustment for medical and demographic confounding variables (beta = -904 g, P = 0.03). The consensus BPD definition is useful to identify those preterm infants who are at greater risk of feeding desaturation and growth delay during infancy and close monitoring of SpO(2) during feeding should be advised.
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Affiliation(s)
- Li-Ying Wang
- School and Graduate Institute of Physical Therapy, National Taiwan University College of Medicine, Taipei, Taiwan
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10
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Abstract
The determination of the appropriate energy and nutritional requirements of a newborn infant requires a clear goal of the energy and other compounds to be administered, valid methods to measure energy balance and body composition, and knowledge of the neonatal metabolic capacities. Providing an appropriate amount of energy to newborn infants remains a challenge considering the great number of newborn infants who suffer in-hospital growth retardation. The energy requirements of a newborn infant are influenced by several factors - basal metabolism, growth, energy expenditure, and energy losses - which change continuously during development. Calculating the energy requirements of preterm infants is subject to error if general recommendations are applied without recognition of the large variation in factors that influence, for example, energy expenditure. Therefore, energy recommendations should be individualized and preferably based on measurements of energy expenditure. In particular, extremely low birth-weight and very low birth-weight infants are prone to develop negative energy and nutrient balances, due to low energy intake, low energy reserves and high energy demands. Early energy accretion is not only essential for growth but also influences neurodevelopmental outcome and physical health in the long term, thereby underlining the importance of adequate neonatal nutrition.
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Affiliation(s)
- Christian V Hulzebos
- Department of Pediatrics, Division of Neonatology, Beatrix Children's Hospital, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands.
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11
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Wood NS, Costeloe K, Gibson AT, Hennessy EM, Marlow N, Wilkinson AR. The EPICure study: growth and associated problems in children born at 25 weeks of gestational age or less. Arch Dis Child Fetal Neonatal Ed 2003; 88:F492-500. [PMID: 14602697 PMCID: PMC1763245 DOI: 10.1136/fn.88.6.f492] [Citation(s) in RCA: 144] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIM To define growth outcomes of a geographically defined population of extremely preterm babies. POPULATION The EPICure study identified all surviving children in the United Kingdom and Ireland born at < or = 25 weeks 6 days gestation between March and December 1995. Of 308 survivors, 283 (92%) were evaluated at 30 months of age corrected for prematurity. METHODS Growth was measured as part of a medical and full neurodevelopmental assessment. Growth parameters were evaluated in relation to other 30 month outcomes and perinatal variables. RESULTS The children were smaller in each of the five growth measures compared with published population norms: mean (SD) standard deviation scores were -1.19 (1.32) for weight, -1.40 (1.37) for head circumference, -0.70 (1.19) for height, -1.00 (1.38) for body mass index, and -0.75 (0.95) for mid-upper arm circumference. Despite being of average size at birth, children were significantly lighter with smaller head circumferences at the expected date of delivery, compared with population norms, and only weight showed later catch up, by 0.5 SD. Poorer growth was found in children whose parents reported feeding problems and with longer duration of oxygen dependency, as a marker for neonatal respiratory illness. Although severe motor disability was associated with smaller head circumference, overall there was no relation between Bayley scores and head growth. CONCLUSIONS Poor growth in early childhood is common in extremely preterm children, particularly when prolonged courses of systemic steroids have been given for chronic lung disease. Improving early growth must be a priority for clinical care.
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Affiliation(s)
- N S Wood
- School of Human Development, University of Nottingham, UK
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12
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Allen J, Zwerdling R, Ehrenkranz R, Gaultier C, Geggel R, Greenough A, Kleinman R, Klijanowicz A, Martinez F, Ozdemir A, Panitch HB, Nickerson B, Stein MT, Tomezsko J, Van Der Anker J. Statement on the care of the child with chronic lung disease of infancy and childhood. Am J Respir Crit Care Med 2003; 168:356-96. [PMID: 12888611 DOI: 10.1164/rccm.168.3.356] [Citation(s) in RCA: 195] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Bauer K, Laurenz M, Ketteler J, Versmold H. Longitudinal study of energy expenditure in preterm neonates <30 weeks' gestation during the first three postnatal weeks. J Pediatr 2003; 142:390-6. [PMID: 12712056 DOI: 10.1067/mpd.2003.143] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES The objective of this study was to measure energy expenditure (EE) in a contemporary population of preterm neonates <30 weeks' gestation. STUDY DESIGN Prospective longitudinal cohort study in 26 consecutive preterm neonates (gestational age, 27 weeks [23-29] [median, range]; birth weight, 980 g [554-1592]). EE was measured by indirect calorimetry on postnatal days 1, 3, 5, 10, and 21. Data on body weight, energy intake, and medical therapy were prospectively collected. RESULTS EE increased from 121 +/- 25 kJ/kg per day (29 +/- 6 kcal/kg per day) (mean +/- SD) on day 1 to 222 +/- 25 kJ/kg per day (53 +/- 6 kcal/kg per day) on day 21. An energy deficit occurred only on day 1. EE was closely related to energy intake: For each additional kJ given, EE increased by 0.3 kJ (r = 0.789, P <.0001). Neonates with a birth weight <1000 g did not have a more pronounced energy deficit than the heavier neonates. EE during nasal continuous positive airway pressure in the first postnatal week was 25% lower than during spontaneous respiration. CONCLUSIONS EE could be predicted from energy intake with acceptable accuracy in preterm neonates <30 weeks' gestation during the first 3 postnatal weeks. There was no prolonged energy deficit.
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Affiliation(s)
- Karl Bauer
- Department of Pediatrics, Universitätsklinikum Benjamin Franklin, Freie Universität Berlin, Germany.
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14
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Huysman WA, de Ridder M, de Bruin NC, van Helmond G, Terpstra N, Van Goudoever JB, Sauer PJJ. Growth and body composition in preterm infants with bronchopulmonary dysplasia. Arch Dis Child Fetal Neonatal Ed 2003; 88:F46-51. [PMID: 12496226 PMCID: PMC1756009 DOI: 10.1136/fn.88.1.f46] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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.
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Affiliation(s)
- W A Huysman
- Department of Pediatrics, Division of Neonatology, Sophia Children's Hospital, Rotterdam, The Netherlands.
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15
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Denne SC. Energy expenditure in infants with pulmonary insufficiency: is there evidence for increased energy needs? J Nutr 2001; 131:935S-937S. [PMID: 11238789 DOI: 10.1093/jn/131.3.935s] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The observed growth failure in infants with pulmonary insufficiency is postulated to be a consequence of elevated rates of energy expenditure. Assessment of energy expenditure by the classical technique of indirect calorimetry has yielded conflicting results. The adoption of the newer, doubly labeled water technique has provided evidence to support increased rates of energy expenditure in infants with chronic lung disease, congenital heart disease and in minimally ill, extremely low birth weight infants. The doubly labeled water technique holds great promise for the detailed study of energy expenditure in a variety of clinical conditions, including very ill as well as free-living subjects.
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Affiliation(s)
- S C Denne
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
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Abstract
The long-term developmental impact of nutrition on the preterm newborn has recently been shown to be of even greater importance than previously recognized. Very immature or ill infants are challenged by the need for a high caloric intake, but are unable to tolerate large fluid volumes. These patients may require enhanced-calorie formulas to achieve the desired growth goals. Formula enhancement has traditionally been performed by uniquely developed recipes of base formula concentration with the addition of powdered formula or single components such as medium-chain triglycerides oil, protein, or polycose. These mixtures have been largely unstudied for bioavailability, long-term outcomes, and tolerance. Deviation from recommended protein, fat, carbohydrate, mineral, and vitamin delivery limits may impair growth or lead to undesirable side effects. The practitioner must have an understanding of when and how to use an enhanced formula and the important monitoring and assessment needs of the patient receiving enhanced-calorie formula.
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Abstract
Information about energy requirements of extremely low-birth weight infants is sparse, despite the rapidly improving survival rates of this population. Metabolizable energy intake can be estimated from energy balance studies and the percentage of caloric intake that is actually absorbed by these infants is approximately 87%. Data on energy expenditure in extremely premature infants is limited; however, energy expenditure has been shown to increase with postnatal age. Because both intake and expenditure are affected by multiple factors, there is significant variability in estimates of the energy requirements in extremely low-birth weight infants. At present, no valid recommendations can be made regarding optimal energy requirements for the extremely low-birth weight infant, except that their requirements probably exceed those of stable, growing very low-birth weight infants, currently estimated at 105 to 135 kcal.kg-1d-1.
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Affiliation(s)
- C A Leitch
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, USA.
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18
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Abstract
In planning enteral feeding in the preterm infant, decisions need to be made regarding the feeding schedule, choice of milk, and the route of administration. Feeds should be commenced within a week after birth beginning with subnutritional quantities. Preterm human milk from the infant's own mother is the milk of choice. When full enteral feeding is established, supplementation with human milk fortifier is recommended. Donor human milk and preterm formula are alternatives. Early establishment of enteral nutrition and maintenance of optimal nutrition during infancy are important as dietary manipulations in preterm infants have potential long-term influences on their health, growth and neurodevelopment.
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Affiliation(s)
- V Y Yu
- Department of Paediatrics, Monash University, Monash Medical Centre, Clayton, Victoria, Australia.
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19
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Brunton JA, Saigal S, Atkinson SA. Growth and body composition in infants with bronchopulmonary dysplasia up to 3 months corrected age: a randomized trial of a high-energy nutrient-enriched formula fed after hospital discharge. J Pediatr 1998; 133:340-5. [PMID: 9738713 DOI: 10.1016/s0022-3476(98)70266-5] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVES (1) To determine whether nutrient malabsorption or inadequate nutrient intake were involved in the cause of growth delay in patients with bronchopulmonary dysplasia, and (2) to determine whether a nutrient-enriched formula given to infants with bronchopulmonary dysplasia to 3 months corrected age improves the rate of growth with greater lean and bone mass accretion when compared with infants fed an isoenergetic standard infant formula. STUDY DESIGN A blinded, nutrition intervention trial of 60 preterm infants with bronchopulmonary dysplasia (birth weight, 866 +/- 169 g, gestational age, 26 +/- 1.5 weeks) randomized to either nutrient-enriched formula or standard formula. Growth, body composition, and nutrient retention were compared between groups by Student's t tests and analysis of covariance. RESULTS Infants fed the enriched formula had significantly greater nitrogen and mineral retention at 38 weeks' postmenstrual age, and only the infants fed enriched formula had zinc retention similar to the intrauterine accretion. At 3 months corrected age infants fed enriched formula attained greater length (P < .05), greater radial bone mineral content (P < .01), and greater lean mass (P < .01). The male infants in the enriched formula group had greater whole body bone mineral content than did male infants in the standard formula group (P = .02). CONCLUSIONS Greater linear growth and lean and bone mass in the enriched formula group suggests that infants with bronchopulmonary dysplasia attain faster "catch-up" growth when fed higher intakes of protein, calcium, phosphorus, and zinc than provided in standard proprietary formulas.
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Affiliation(s)
- J A Brunton
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
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Bernstein S, Heimler R, Sasidharan P. Approaching the management of the neonatal intensive care unit graduate through history and physical assessment. Pediatr Clin North Am 1998; 45:79-105. [PMID: 9491088 DOI: 10.1016/s0031-3955(05)70584-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
NICU graduates, often ex-premature infants, offer unusual challenges to the primary care provider. History and physical assessment require an organized approach with meticulous attention to detail. These infants are at high risk for multiple problems including growth delays, nutrition and feeding problems, pulmonary sequelae, neurological sequelae and developmental delays, vision and hearing disturbances, as well as abnormalities in parent-infant bonding. This article emphasizes particular aspects of the history and physical examination that signify pathophysiology and sequelae common to the NICU graduate.
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Affiliation(s)
- S Bernstein
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, USA
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21
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Battaglia FC, Marconi AM. The new obstetrics: its integration into neonatal clinical practise, teaching and research. J Perinat Med 1998; 25:399-405. [PMID: 9438944 DOI: 10.1515/jpme.1997.25.5.399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Most neonatologists have not yet incorporated into their teaching, clinical service and research the advances in high risk obstetrics particularly as it relates to fetal surveillance. This brief review emphasizes some of the "new obstetrics" from the viewpoint of perinatal medicine, particularly in terms of neonatal teaching and the design of future neonatal research. The information that can be obtained about an infant prenatally by the use of ultrasound. power doppler, computerized fetal heart rate monitoring, cordocentesis, etc is extensive and yet, has rarely been utilized in the design of neonatal research protocols. It is becoming imperative that the "new obstetrics" be recognized and utilized in modern neonatal thinking if a truly "perinatal medicine" is to be practised.
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Affiliation(s)
- F C Battaglia
- Department of Pediatrics and Obstetrics-Gynecology, University of Colorado School of Medicine, Denver, USA
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Fewtrell MS, Adams C, Wilson DC, Cairns P, McClure G, Lucas A. Randomized trial of high nutrient density formula versus standard formula in chronic lung disease. Acta Paediatr 1997; 86:577-82. [PMID: 9202790 DOI: 10.1111/j.1651-2227.1997.tb08937.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
To test the hypothesis that the nutrient intake and growth of infants with chronic lung disease would be improved by providing nutrients in more concentrated form, and that the lower volume would improve respiratory status, 60 preterm infants requiring supplemental oxygen at 28 days of age were randomly assigned a low-density (24 kcal/oz) formula fed at 180 ml/kg/day, or a high-density (30 kcal/oz) formula at 145 ml/kg/day. There was no difference in growth, respiratory outcome, oedema or diuretic requirement between dietary groups. Infants fed the high nutrient density formula had significantly greater total energy (143 vs 134 kcal/kg/day) and protein (3.9 vs 3.6 g/kg/day) intakes, largely because the low-density formula group did not achieve the designated 180 ml/kg/day. In conclusion, use of a high-density formula in infants with chronic lung disease did not improve growth or respiratory outcome, despite a small increase in total energy and protein intake.
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Affiliation(s)
- M S Fewtrell
- Infant and Child Nutrition Group, MRC Dunn Nutrition Unit, Cambridge, UK
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24
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Abstract
OBJECTIVE To review existing data on nutritional requirements of extremely low birth weight (ELBW) and very low birth weight (VLBW) preterm infants (those who weigh < 1000 g and 1000-1500 g at birth, respectively), and the effects of diseases on these nutritional requirements. DATA SOURCES A literature search was conducted on applicable articles related to nutritional requirements of preterm ELBW and VLBW infants and the effects of diseases in these infants on their nutritional and metabolic requirements. DATA SYNTHESIS The literature was analyzed to determine nutritional requirements of preterm ELBW and VLBW infants, to select the most common diseases that have significant and important effects on nutrition and metabolism in these infants, and to make recommendations about diagnostic and therapeutic approaches to nutritional problems as affected by diseases in ELBW and VLBW infants. CONCLUSIONS Many diseases unique to preterm infants, either directly or by enhancing the effects of stress on the metabolism of such infants, provide important changes in the nutrient requirements. The overriding observation from all studies, however, is that ELBW and VLBW preterm infants are underfed during the early postnatal period and that this condition, combined with additional stresses from various diseases, increases the risk of long-term neurological sequelae. The value of achieving a specific body composition and growth weight is less certain. There remains a critical need for determining the right quality as well as quantity of nutrients for these infants.
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Affiliation(s)
- W W Hay
- Department of Pediatrics, University of Colorado School of Medicine, Denver 80262, USA
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25
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Lee JK, Yu VY. Calorie intake in sick versus respiratory stable very low birthweight babies. ACTA PAEDIATRICA JAPONICA : OVERSEAS EDITION 1996; 38:449-54. [PMID: 8942002 DOI: 10.1111/j.1442-200x.1996.tb03525.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
A comparison between the calorie intake and energy source of sick versus respiratory stable very low birthweight (VLBW, less than 1500 g) babies was made to ascertain the time taken for them to achieve adequate daily calorie intake. It was an observational study of 23 consecutive VLBW babies in which sick respiratory unstable babies were defined as those who required ventilation beyond 72 h of life. Data were collected on the daily fluid and calorie intake for 30 days of life, and beyond if necessary until the babies achieved full enteral feeding and calorie intake of more than 100 kcal/kg per day. Growth parameters at the time of transfer or discharge were also analyzed. In the study, there were 14 sick VLBW and 9 respiratory stable babies with a mean birthweight of 1027 g and 1212 g, respectively. Their mean gestational age (28.7 weeks vs 31.2 weeks), mean age when calorie intake of 100 kcal/kg per day was achieved (19.8 days vs 7.0 days), mean duration of parenteral nutrition (17.1 days vs 2.7 days), mean age when enteral feeds commenced (8.9 days vs 1.7 days) and mean age when full enteral feeding was established (20.6 days vs 7.3 days) were statistically different for the two groups. For the respiratory unstable babies, parenteral nutrition provided more energy than milk until 15 days of life. The average daily energy intake of 100 kcal/kg per day was only achieved by 30 days of life in this group. In the respiratory stable group, milk provided more than 100 kcal/kg per day from 10 days of life. There were no significant differences in somatic growth with regard to bodyweight, length and head circumference for these two groups of babies at the time of transfer or discharge. The daily calorie intake of sick VLBW babies was suboptimal even with the use of parenteral nutrition. The respiratory stable babies, through enteral feeding, easily achieved the recommended daily calorie intake.
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Affiliation(s)
- J K Lee
- Neonatal Intensive Care Unit, Monash Medical Centre, Clayton, Victoria, Australia
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26
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Abstract
In 10 hyaline membrane disease patients with development of bronchopulmonary dysplasia, 16 hyaline membrane disease patients without development of bronchopulmonary dysplasia, and 12 very-low-birthweight infants without major medical problems, we measured the lipase and trypsin activity as well as the bile acids concentrations in preprandially aspirated duodenal juice. In addition, fat and nitrogen balances were performed during the 5th and 6th weeks of postnatal life. The mean duodenal lipase activity in the patients with bronchopulmonary dysplasia was significantly lower than those of the patients without bronchopulmonary dysplasia (4.41 +/- 3.0 versus 9.95 +/- 3.0 U/ml, p < 0.05) and of the controls (19.94 +/- 6.8 U/ml). The mean total bile acid concentration was below the critical micellar concentration of 4 mmol/L only in the patients with bronchopulmonary dysplasia. The fecal fat excretion rate in the patients with bronchopulmonary dysplasia was significantly higher than in the patients without bronchopulmonary dysplasia (21.4 +/- 4.6% versus 11.3 +/- 3.4% of intake, p < 0.01) as well as that of the controls (7.9 +/- 2.8% of intake). The serum urea concentrations were similar in the patients without bronchopulmonary dysplasia and in the controls (1.97 +/- 0.6 and 1.89 +/- 0.4 mmol/L, respectively) but significantly higher in the patients with bronchopulmonary dysplasia (2.54 +/- 0.5 mmol/L). The lowest weight gain was found in the patients with bronchopulmonary dysplasia (8.2 +/- 4.7 g/kg/day). It was significantly lower than one of the patients without bronchopulmonary dysplasia or the controls (13.5 +/- 4.0 and 16.2 +/- 3.7 g/kg/day, respectively). The data indicate that patients who develop bronchopulmonary dysplasia have a limited fat absorption, which may help to explain the inadequate weight gain.
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Affiliation(s)
- G Boehm
- Center for Infant Nutrition to Prevent Illnesses in Adult Life, Maternity Hospital Macedonio Melloni, Milan, Italy
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27
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Adan D, La Gamma EF, Browne LE. Nutritional Management and the Multisystem Organ Failure/systemic Inflammatory Response Syndrome in Critically Ill Preterm Neonates. Crit Care Clin 1995. [DOI: 10.1016/s0749-0704(18)30063-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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28
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Wilson DC, McClure G. Energy requirements in sick preterm babies. ACTA PAEDIATRICA (OSLO, NORWAY : 1992). SUPPLEMENT 1994; 405:60-4. [PMID: 7734793 DOI: 10.1111/j.1651-2227.1994.tb13400.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The energy requirements of healthy preterm babies are well documented in the literature. However, the clinical load in neonatal intensive care units is due to sick preterm infants requiring prolonged mechanical ventilation, many of whom will develop bronchopulmonary dysplasia. It is this group in which knowledge of energy requirements is scanty. This group also has poor energy reserves and is often intolerant of enteral and parenteral nutrition. In this article, we will review methods of measurement of energy expenditure, methodological problems when applied to ill infants and published results of energy expenditure measurements in sick preterm babies. We will review the link between energy reserves, energy intake and energy expenditure. The problems of undernutrition in early postnatal life and possible consequences in adult life will be discussed.
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Affiliation(s)
- D C Wilson
- Royal Maternity Hospital, Belfast, Northern Ireland
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29
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Stuber ML, Gonzalez S, Meeske K, Guthrie D, Houskamp BM, Pynoos R, Kazak A. Post-traumatic stress after childhood cancer II: A family model. Psychooncology 1994. [DOI: 10.1002/pon.2960030408] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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30
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Rozé JC, Chambille B, Dehan M, Gaultier C. Measurement of oxygen uptake in newborn infants during assisted and spontaneous ventilation. RESPIRATION PHYSIOLOGY 1994; 98:227-39. [PMID: 7817052 DOI: 10.1016/0034-5687(94)00056-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Measurements of oxygen uptake (VO2) and CO2 output (VCO2) are useful in critically ill patients. However, VO2 is not routinely measured in intensive care during mechanical ventilation (MV) especially in premature newborns. The present study describes a new method of measuring VO2 and VCO2 using a double open circuit which accounts for gas leaks around the uncuffed tracheal tube. The accuracy of the method was assessed with N2 and CO2 infusion. In case of leaks, VO2 and VCO2 measurement was significantly underestimated by the simple circuit method. This underestimation was not present with double circuit method. Five preterm newborns were studied. VO2 and VCO2 using the double open circuit were compared with the classic simple circuit. During MV, the mean underestimation assessed by the difference between simple and double circuit measurement was -12% (range from 0 to -29%) for VO2 and -14% (range 0 to -26%) for VCO2.
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Affiliation(s)
- J C Rozé
- Neonatal Department, Hôpital Universitaire, Nantes, France
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31
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Abstract
Improvements in neonatal and pediatric intensive care have produced a growing population of children dependent on mechanical ventilation for survival. Long-term mechanical ventilation has become a realistic alternative to death from progressive respiratory failure for many children with chronic respiratory illness. This article reviews the pathophysiology, etiology, and management of chronic respiratory failure in childhood.
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Affiliation(s)
- S L Pilmer
- Department of Anesthesiology and Pediatrics, University of Pennsylvania, Philadelphia
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32
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Abstract
The epidemiology of many conditions affecting the newborn infant is influenced by the health of the mother, prematurity and the effects of medical and obstetric management. In this review we have considered the role of each of these factors in seven respiratory conditions presenting in the newborn infant.
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Affiliation(s)
- S Bohin
- Department of Child Health, Leicester Royal Infirmary, UK
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33
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Abstract
Although much has been learned about BPD in the 25 years since its initial description, BPD remains a significant complication of prematurity. Substantial advances into the understanding of its pathophysiology and pathogenesis have been made and are reflected in new therapeutic interventions. Much current research is directed towards the role of prevention, exploring new approaches for accelerating lung maturation with combined maternal steroid and thyrotropin releasing hormone (TRH) therapy, surfactant replacement therapy, high frequency oscillatory ventilation, antioxidant administration, manipulation of endogenous antioxidants, and other pharmacologic strategies to minimize lung injury. The impact of other technologies, such as synchronized intermittent mandatory ventilation, perfluorocarbon (liquid) ventilation, and perhaps inhaled nitric oxide therapy may become additional parts of the clinical regimen for some cases of severe neonatal respiratory failure. Less information is available on mechanisms which can hasten lung healing. Ongoing studies of inflammatory products, growth factors, and cytokines may lead to new therapies which will favorably influence the fibroproliferative phase of disease. In the meantime, the medical and social impact of BPD continues to remain a significant problem not only during infancy but also throughout life. Mildred Stahlman, MD, recently wrote that (a)s sanguine as the future looks for surfactant therapy, it may leave us with more very low-birth weight infants who survive, whose potential for normal pulmonary growth and development is unknown, and whose very immature organ systems, besides the lung, are still susceptible to metabolic, neurologic, and other problems. As more survivors are reaching young adulthood, respiratory and neurodevelopmental complications persist. Thus, as advances in the care of the premature newborn with respiratory distress have dramatically improved survival, the management of chronic lung disease and related problems remains a continuing challenge.
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Affiliation(s)
- S H Abman
- Department of Pediatrics, University of Colorado School of Medicine, Denver
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34
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Pereira GR, Baumgart S, Bennett MJ, Stallings VA, Georgieff MK, Hamosh M, Ellis L. Use of high-fat formula for premature infants with bronchopulmonary dysplasia: metabolic, pulmonary, and nutritional studies. J Pediatr 1994; 124:605-11. [PMID: 8151479 DOI: 10.1016/s0022-3476(05)83143-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The use of dietary fat in preference to carbohydrate offers the theoretic advantage of diminishing carbon dioxide production and thus the respiratory quotient, which may be beneficial for babies with chronic lung disease. Ten premature infants (birth weight (mean +/- SEM), 1.13 +/- 0.12 kg; postnatal age, 9 +/- 1 weeks) with bronchopulmonary dysplasia were alternately fed a high-fat and a high-carbohydrate formula each for 1 week, in randomized order. Lower rates of carbon dioxide production (6.6 +/- 0.3 versus 7.4 +/- 0.4 ml/kg per minute; p < 0.05), and consequently lower respiratory quotients (0.80 +/- 0.02 versus 0.94 +/- 0.01 ml/kg per minute; p < 0.005), were observed during the administration of the high-fat formula. There were no significant differences in results of pulmonary function tests with the use of either formula. Both formulas were equally well tolerated and able to promote adequate growth and normal biochemical profiles. However, weight gain was significantly greater with the administration of the high-carbohydrate formula, possibly because of an increase in the accretion of body fat. We conclude that the short-term use of high-fat formula for infants with bronchopulmonary dysplasia decreases carbon dioxide production while maintaining adequate growth and nutritional status.
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Affiliation(s)
- G R Pereira
- Department of Pediatrics, University of Pennsylvania School of Medicine, Children's Hospital of Philadelphia 19104
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35
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Wahlig TM, Gatto CW, Boros SJ, Mammel MC, Mills MM, Georgieff MK. Metabolic response of preterm infants to variable degrees of respiratory illness. J Pediatr 1994; 124:283-8. [PMID: 8301440 DOI: 10.1016/s0022-3476(94)70321-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
In older children and adults, physiologic instability associated with severe illness causes increased cellular oxygen consumption (VO2), increased serum lactate and cortisol levels, and more negative nitrogen balance. To determine the metabolic response of preterm infants to severity of respiratory illness, we analyzed VO2, nitrogen balance, urinary 3-methyl-histidine and norepinephrine concentrations, and serum levels of lactate and cortisol as a function of ventilatory index (VI). Twelve 2-day-old premature infants who were appropriate in size for gestational age (mean +/- SEM birth weight: 1460 +/- 251 gm) and who required mechanical ventilation for respiratory distress syndrome had VO2 and carbon dioxide production measured by indirect calorimetry and blood and urine samples obtained concurrently. All infants received amino acids, 1.0 gm/kg per day, and a mean energy intake of 27 +/- 3 kcal/kg per day, provided as a parenteral dextrose solution. The resting energy expenditure exceeded energy intake in all infants. The VO2 value ranged from 5.5 to 9.2 ml/kg per minute and was directly correlated with VI (r = 0.79; p = 0.002). Nitrogen balance ranged from -160 to 53 mg/kg per day (mean: -33 +/- 21 mg/kg per day) but was not dependent on VI (r = 0.04) or VO2 (r = 0.01). The serum lactate level correlated directly with VI (r = 0.82; p = 0.002) and VO2 (r = 0.60; p = 0.05), but cortisol and urinary norepinephrine levels did not. We conclude that preterm infants with respiratory distress syndrome have increased VO2 rates and serum lactate concentrations directly related to the degree of respiratory illness. They are generally in a state of mildly negative nitrogen balance, the degree of which is not related to severity of illness. Although these infants may require increased energy delivery during illness, they do not appear to require excessive amounts of amino acids.
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Affiliation(s)
- T M Wahlig
- Division of Neonatology, Children's Hospital of St. Paul, MN
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36
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Abstract
Knemometry has been used to measure lower leg growth during 32 nine day courses of dexamethasone in 26 babies ranging from 24 to 32 weeks' gestation at birth. Mean leg length velocity was 0.37 mm/day in the 10 days before steroids. Administration of dexamethasone was associated with a decrease in velocity in all babies, and in 15 leg shortening was documented. Mean leg length velocity during steroid treatment was -0.003 mm/day. After the course of dexamethasone was completed there was an immediate increase in leg length velocity to a mean of 0.52 mm/day over the first 10 days then falling to a value similar to the growth velocity observed before treatment. Leg length had reached the value predicted by growth before steroids about 30 days after dexamethasone. The reduction in leg length velocity occurred despite a significant increase in energy intake and decrease in oxygen requirements.
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37
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Itabashi K, Takeuchi T, Okuyama K, Kuriya N, Ohtani Y. Postnatal growth curves of very low birthweight Japanese infants. ACTA PAEDIATRICA JAPONICA : OVERSEAS EDITION 1992; 34:648-55. [PMID: 1285513 DOI: 10.1111/j.1442-200x.1992.tb01025.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
To construct standard growth curves for Japanese infants of very low birthweight, longitudinal data provided by 47 neonatal centers in Japan were reviewed. Data were collected on the growth of infants admitted to those units during 1986 and 1987 and who survived beyond 3 years of age. A total of 379 singleton infants, who were free of neurological sequelae and appropriate for gestational age, were enrolled. Those whose birthweights were more than 600 g and less than 1,500 g were grouped into nine weight categories separated by increments of 100 g. Data on the increase in weight and head circumference were compiled and analyzed until more than half the infants in each weight category had been discharged from each site. Growth curves of bodyweight and head circumference in the nine groups were constructed using polynomial regression analysis to define the curve of best fit. With increasing prematurity, significant trends of greater weight loss (P < 0.05), longer time to reach the lowest weight (P < 0.01) and a longer time to regain birthweight (P < 0.01) were observed. In addition, there was a significantly higher incidence of chronic lung disease in such groups (P < 0.0001). Growth curves were characterized by the average clinical profiles in each of the nine groups. We believe that these data will be useful in evaluating the growth of very low birthweight infants being cared for in modern neonatal intensive care units in Japan.
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Affiliation(s)
- K Itabashi
- Department of Pediatrics, Showa University School of Medicine, Tokyo, Japan
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38
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Tammela OK, Koivisto ME. Fluid restriction for preventing bronchopulmonary dysplasia? Reduced fluid intake during the first weeks of life improves the outcome of low-birth-weight infants. Acta Paediatr 1992; 81:207-12. [PMID: 1511192 DOI: 10.1111/j.1651-2227.1992.tb12205.x] [Citation(s) in RCA: 75] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
One hundred consecutive low-birth-weight infants (less than 1751 g) were randomized equally into "dry" and "control" groups. Fluid administration in the dry group followed the schema 50, 60, 70, 80, 90, 100 and 120 ml/kg/day during the first week and 150 ml/kg/day until aged four weeks and that of the control group 80, 100, 120 and 150 ml/kg/day during the first week and 200 ml/kg afterwards. The diagnosis of bronchopulmonary dysplasia was based on typical roentgenographic findings, clinical symptoms and a supplemental oxygen requirement at age one month. Mean weight loss was greater in the dry group than in the control group (8.8 vs 6.2%), but there was no difference in weight between the groups at the age of four weeks. Twelve of the patients died, one in the dry group and 11 in the control group (five died during the first 24 h and the remaining six between three days and three months). Twenty-seven subjects in the dry group and 15 in the control group were alive and had no signs of bronchopulmonary dysplasia at age 28 days (p less than 0.05), the numbers at term being 28 and 14, respectively (p less than 0.01). These results suggest that fluid restrictions can reduce the mortality and morbidity of low-birth-weight infants. Infants of this kind, with respiratory distress, show poor tolerance to fluids, especially during the first weeks of life.
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Affiliation(s)
- O K Tammela
- Department of Pediatrics, University of Oulu, Finland
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39
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Wilson DC, McClure G, Dodge JA. The influence of nutrition on neonatal respiratory muscle function. Intensive Care Med 1992; 18:105-8. [PMID: 1613188 DOI: 10.1007/bf01705042] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Advances in neonatal intensive care have resulted in increasing survival of very small babies, who often require prolonged periods of mechanical ventilation. These babies have limited nutritional reserves, and are difficult to feed by either parenteral or enteral routes. This review article discusses the interaction between undernutrition and respiratory muscle function in the critically ill preterm baby.
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Affiliation(s)
- D C Wilson
- Royal Maternity Hospital, Belfast, Northern Ireland
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40
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Talbot JM. Guidelines for the scientific review of enteral food products for special medical purposes. Prepared for the Center for Food Safety and Applied Nutrition, Food and Drug Administration. JPEN J Parenter Enteral Nutr 1991; 15:99S-174S, A1-E2. [PMID: 1906947 DOI: 10.1177/014860719101500301] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- J M Talbot
- Life Sciences Research Office, Federation of American Societies for Experimental Biology, Bethesda, Maryland 20814
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41
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Abstract
Twenty two babies who developed bronchopulmonary dysplasia were compared with 22 babies matched for gestational age who did not. Those with bronchopulmonary dysplasia weighed less at birth and had lower energy intakes from day 7 to day 56. Undernutrition before and after birth is a major problem in babies who develop bronchopulmonary dysplasia.
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Affiliation(s)
| | | | | | - M M Reid
- Royal Maternity Hospital, Belfast
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42
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Affiliation(s)
- W H Northway
- Department of Diagnostic Radiology and Nuclear Medicine, Stanford University School of Medicine, California 94305-5105
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43
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Affiliation(s)
- S C Kalhan
- Department of Pediatrics, Case Western Reserve University, Cleveland, OH 44106
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44
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45
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Bancalari E, Sosenko I. Pathogenesis and prevention of neonatal chronic lung disease: recent developments. Pediatr Pulmonol 1990; 8:109-16. [PMID: 2191258 DOI: 10.1002/ppul.1950080209] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- E Bancalari
- Department of Pediatrics, University of Miami School of Medicine, Florida
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