Abstract
Bronchopulmonary dysplasia (BPD) remains the most common severe complication of preterm birth, and nutrition plays a crucial role in lung growth and repair. A practical nutritional approach for infants at risk of BPD or with established BPD is provided based on a comprehensive literature review. Ideally, infants with BPD should receive a fluid intake of not more than 135–150 mL/kg/day and an energy intake of 120–150 kcal/kg/day. Providing high energy in low volume remains a challenge and is the main cause of growth restriction in these infants. They need a nutritional strategy that encompasses early aggressive parenteral nutrition and the initiation of concentrated feedings of energy and nutrients. The order of priority is fortified mother’s own milk, followed by fortified donor milk and preterm enriched formulas. Functional nutrient supplements with a potential protective role against BPD are revisited, despite the limited evidence of their efficacy. Specialized nutritional strategies may be necessary to overcome difficulties common in BPD infants, such as gastroesophageal reflux and poorly coordinated feeding. Planning nutrition support after discharge requires a multidisciplinary approach to deal with multiple potential problems. Regular monitoring based on anthropometry and biochemical markers is needed to guide the nutritional intervention.
Highlights
Bronchopulmonary dysplasia (BPD), named chronic lung disease of prematurity, is a lung disease that causes dependence on oxygen for an extended period of time [1,2,3].The “new BPD” seen today results from a reparative process in alveolar and vascular compartments of the lung, after injury caused by ante- and postnatal pathogenic factors leading to reduced, large, thin-walled alveoli, and less fibrosis when compared to the “old BPD” [2].The definition of BPD has been a challenging issue
In a retrospective cohort study of extremely low birth weight (ELBW) infants, it was found that high fluid intake during the first postnatal week and lack of physiological weight loss in the first 10 postnatal days were associated with an increased risk of BPD [31]
Clinical trials showed that intramuscular administration of vitamin A decreased the risk of BPD in ELBW infants [62,63]
Summary
Bronchopulmonary dysplasia (BPD), named chronic lung disease of prematurity, is a lung disease that causes dependence on oxygen for an extended period of time [1,2,3]. BPD remains the most common severe complication of preterm birth and is characterized by a high grade of inflammation of the immature lung [8,9]. It represents a major challenge for neonatologists who deal with modifiable risk factors for BPD development, including surfactant replacement therapy, ventilation strategies, corticosteroids, inhaled nitric oxide, inhaled bronchodilators, and macrolides [10,11]. A retrospective cohort study reported that, in extremely preterm infants, high fluid intake containing low energy during the first postnatal week is associated with the severity of BPD [20]. Other studies have described the association of postnatal deficit in energy and nutrient and postnatal growth restriction with the development of BPD [21,22,23,24]
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