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Heras A, Chambers R, Solomon Z, Blatt L, Martin CR. Nutrition-based implications and therapeutics in the development and recovery of bronchopulmonary dysplasia. Semin Perinatol 2023; 47:151818. [PMID: 37775366 DOI: 10.1016/j.semperi.2023.151818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/01/2023]
Abstract
Premature births account for over 10% of live births worldwide. Bronchopulmonary dysplasia (BPD) represents a severe sequela in neonates born very prematurely and remains the most common chronic neonatal lung disease, often leading to serious adverse consequences in adulthood. Nutrition plays a crucial role in lung development and repair. Ongoing research has primarily focused on the pathogenesis and prevention of BPD in preterm birth. However, infants with established BPD need specialist medical care that persists throughout their hospitalization and continues after discharge. This manuscript aims to highlight the impact of growth and nutrition on BPD and highlight research gaps to provide direction for future studies. Protective practices include ensuring adequate early energy delivery through parenteral nutrition and enteral feedings while carefully monitoring total fluid intake and the use of breast milk over formula. These nutritional strategies remain the same for infants with established BPD with the addition of limiting the use of diuretics and steroids; but if employed, monitoring carefully without compromising total energy delivery. Functional nutrient supplements with a potential protective role against BPD are revisited, despite the limited evidence of their efficacy, including vitamins, trace elements, zinc, lipids, and sphingolipids. Planning post-intensive care and outpatient longitudinal nutrition support is critical in caring for an infant with established BPD.
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Affiliation(s)
- Andrea Heras
- Department of Pediatrics, Division of Pediatric Pulmonology, Weill Cornell Medicine, Komansky Children's Hospital, New York, NY, United States
| | - Rachel Chambers
- NewYork-Presbyterian Food& Nutrition Services, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, NY, United States
| | - Zenna Solomon
- Department of Pediatrics, Division of Pediatric Pulmonology, Weill Cornell Medicine, Komansky Children's Hospital, New York, NY, United States
| | - Lauren Blatt
- Department of Pediatrics, Division of Neonatology, Weill Cornell Medicine, Komansky Children's Hospital, New York, NY, United States
| | - Camilia R Martin
- Department of Pediatrics, Division of Neonatology, Weill Cornell Medicine, Komansky Children's Hospital, New York, NY, United States.
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Lima PAT, Méio MDBB, Moreira MEL, de Abranches AD, Milanesi BG, Gomes Junior SCS. Energy expenditure and body composition in infants with bronchopulmonary dysplasia at term age. Eur J Pediatr 2022; 181:3039-3047. [PMID: 35661246 DOI: 10.1007/s00431-022-04517-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 05/26/2022] [Accepted: 05/29/2022] [Indexed: 11/28/2022]
Abstract
UNLABELLED In this cross-sectional study, conducted in a cohort of infants with a gestational age of < 32 weeks, we aimed to evaluate and compare resting energy expenditure (REE) and body composition between infants who developed bronchopulmonary dysplasia (BPD) and those who did not. REE and body composition were assessed at term equivalent age using indirect calorimetry and air displacement plethysmography. Anthropometric measurements (weight, head circumference, and length) were obtained and transformed into Z-scores per the Fenton (2013) growth curve, at birth and at term equivalent age. Forty-two infants were included in this study, of which 26.2% developed BPD. Infants with BPD had significantly higher energy expenditure at term equivalent age, with no difference in body composition between the two groups. CONCLUSION Despite expending more energy, infants with BPD maintained a similar body composition distribution to those without BPD, and this is likely due to the recommended nutritional approach. WHAT IS KNOWN • Greater resting energy expenditure impairs growth of preterm infants with bronchopulmonary dysplasia. WHAT IS NEW • Although preterm infants with bronchopulmonary dysplasia had a higher resting energy expenditure at the corrected term age, this did not affect their body composition and growth.
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Affiliation(s)
- Paola Azara Tabicas Lima
- Instituto Nacional da Mulher, da Criança e do Adolescente Fernandes Figueira, Oswaldo Cruz Foundation, FIOCRUZ, Neonatology Rio de Janeiro/RJ, Brazil
| | - Maria Dalva Barbosa Baker Méio
- Instituto Nacional da Mulher, da Criança e do Adolescente Fernandes Figueira, Oswaldo Cruz Foundation, FIOCRUZ, Neonatology Rio de Janeiro/RJ, Brazil. .,Applied Clinical Research, Instituto Nacional da Mulher, da Criança E do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz, FIOCRUZ, Rio de Janeiro/RJ, Brazil.
| | - Maria Elisabeth Lopes Moreira
- Instituto Nacional da Mulher, da Criança e do Adolescente Fernandes Figueira, Oswaldo Cruz Foundation, FIOCRUZ, Neonatology Rio de Janeiro/RJ, Brazil.,Applied Clinical Research, Instituto Nacional da Mulher, da Criança E do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz, FIOCRUZ, Rio de Janeiro/RJ, Brazil
| | - Andrea Dunshee de Abranches
- Instituto Nacional da Mulher, da Criança e do Adolescente Fernandes Figueira, Oswaldo Cruz Foundation, FIOCRUZ, Neonatology Rio de Janeiro/RJ, Brazil
| | - Brunna Grazziotti Milanesi
- Instituto Nacional da Mulher, da Criança e do Adolescente Fernandes Figueira, Oswaldo Cruz Foundation, FIOCRUZ, Neonatology Rio de Janeiro/RJ, Brazil
| | - Saint Clair S Gomes Junior
- Applied Clinical Research, Instituto Nacional da Mulher, da Criança E do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz, FIOCRUZ, Rio de Janeiro/RJ, Brazil
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Tran HT, Le TD, Skinner A, Narchi H. Very preterm infants admitted to a tertiary neonatal unit in central Vietnam showed poor postnatal growth. Acta Paediatr 2022; 111:307-313. [PMID: 34536961 DOI: 10.1111/apa.16116] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 09/13/2021] [Accepted: 09/16/2021] [Indexed: 11/28/2022]
Abstract
AIM We aimed to evaluate the postnatal growth of very preterm infants. METHODS This was a cross-sectional observational study of neonates born before 32 weeks of gestation and admitted to the neonatal unit at Da Nang Hospital for Women and Children, Vietnam, between 1 February 2020 and 30 September 2020. Morbidities, therapies, nutrition modalities and growth status were recorded from admission to discharge. RESULTS The 78 infants (51% female) were born at a median of 29 weeks and mean birth weight of 1247 grams. The mean weight gain velocity from regaining their birth weight until discharge was 12.7 ± 4.9 g/kg/d. At discharge, the Z-scores for weight, length, both weight and length and weight for length were lower than at birth in 94%, 67%, 64% and 95% of infants and the Delta Z-scores were less than -1 in 73%, 44%, 39% and 82%. Late-onset sepsis (LOS) and bronchopulmonary dysplasia (BPD) were significantly associated with growth failure, with adjusted odds ratios of 3.6 and 20.1, respectively. CONCLUSION The high rate of poor growth among the very preterm infants in our study indicates the need to reduce LOS and BPD and ensure the availability of human milk fortifier, vitamin and mineral supplements.
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Affiliation(s)
- Hoang Thi Tran
- Neonatal UnitDa Nang Hospital for Women and Children Da Nang Vietnam
- Department of Paediatrics School of Medicine and Pharmacy Da Nang University Da Nang Vietnam
| | - Thao Dieu Le
- Neonatal UnitDa Nang Hospital for Women and Children Da Nang Vietnam
- Department of Paediatrics School of Medicine and Pharmacy Da Nang University Da Nang Vietnam
| | - Alyson Skinner
- Department of Paediatrics Manor HospitalWalsall Healthcare NHS Trust Walsall UK
- Department of Paediatrics College of Medicine and Health Sciences United Arab Emirates University Al Ain United Arab Emirates
| | - Hassib Narchi
- Department of Paediatrics College of Medicine and Health Sciences United Arab Emirates University Al Ain United Arab Emirates
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Milanesi BG, Lima PA, Villela LD, Martins AS, Gomes-Junior SCS, Moreira MEL, Méio MDBB. Assessment of early nutritional intake in preterm infants with bronchopulmonary dysplasia: a cohort study. Eur J Pediatr 2021; 180:1423-1430. [PMID: 33389073 DOI: 10.1007/s00431-020-03912-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 11/18/2020] [Accepted: 12/16/2020] [Indexed: 10/22/2022]
Abstract
This cohort study evaluated the nutritional supply in 78 very preterm newborns, with 20.5% developing bronchopulmonary dysplasia (BPD). This work aimed to evaluate the nutritional intake and the calorie/protein ratio received in the first 4 weeks of life. Anthropometric measures at birth and term age, the weight at each of the first 4 weeks of life, and the feeding practices were registered. The mean gestational age and birth weight were lower in those who developed BPD. At term age, head circumference and length Z-scores were significantly lower in newborns with BPD, who started enteral feeding and reached full diet later, staying longer in parenteral nutrition. The protein rate received by all newborns was similar, whether developing BPD or not, but those who developed BPD received significantly lower fluid volume and calorie rates after the second week. The daily calorie/protein ratio (30 kcal/1-g protein) was reached by 88.7% of the newborns who did not develop BPD in the third week, with those who developed BPD receiving less than this ratio until the second week, persisting in 56.3% of them on the fourth week.Conclusion: A calorie/protein ratio below that recommended for growth was found in preterm newborns who developed BPD, and providing nutrition for these newborns remains a challenge. What is Known: • The importance of preterm newborn nutrition is well known. • Early nutritional support may avoid severe BPD. What is New: • Newborns who developed BPD received a calorie/protein ratio below that recommended for preterm newborns' growth during the first 2 weeks of life, lasting until the fourth week in most of these newborns.
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Affiliation(s)
- Brunna G Milanesi
- Neonatology, Instituto Nacional da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz, FIOCRUZ, Av. Rui Barbosa, 760, Flamengo, RJ, CEP 22250-020, Rio de Janeiro, Brazil
| | - Paola At Lima
- Neonatology, Instituto Nacional da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz, FIOCRUZ, Av. Rui Barbosa, 760, Flamengo, RJ, CEP 22250-020, Rio de Janeiro, Brazil
| | - Letícia D Villela
- Neonatology, Instituto Nacional da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz, FIOCRUZ, Av. Rui Barbosa, 760, Flamengo, RJ, CEP 22250-020, Rio de Janeiro, Brazil
| | - Amanda S Martins
- Neonatology, Instituto Nacional da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz, FIOCRUZ, Av. Rui Barbosa, 760, Flamengo, RJ, CEP 22250-020, Rio de Janeiro, Brazil
| | - Saint Clair S Gomes-Junior
- Neonatology, Instituto Nacional da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz, FIOCRUZ, Av. Rui Barbosa, 760, Flamengo, RJ, CEP 22250-020, Rio de Janeiro, Brazil.,Post-graduation on Applied Clinical Research, Instituto Nacional da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, Brazil
| | - Maria E L Moreira
- Neonatology, Instituto Nacional da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz, FIOCRUZ, Av. Rui Barbosa, 760, Flamengo, RJ, CEP 22250-020, Rio de Janeiro, Brazil.,Post-graduation on Applied Clinical Research, Instituto Nacional da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, Brazil
| | - Maria Dalva Barbosa Baker Méio
- Neonatology, Instituto Nacional da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz, FIOCRUZ, Av. Rui Barbosa, 760, Flamengo, RJ, CEP 22250-020, Rio de Janeiro, Brazil. .,Post-graduation on Applied Clinical Research, Instituto Nacional da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, Brazil. .,, Rio de Janeiro, Brazil.
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