Correlation of Early Nutritional Supply and Development of Bronchopulmonary Dysplasia in Preterm Infants <1,000 g

Background: Bronchopulmonary dysplasia (BPD) has multifactorial origins and is characterized by distorted physiological lung development. The impact of nutrition on the incidence of BPD is less studied so far.Methods: A retrospective single center analysis was performed on n = 207 preterm infants <1,000 g and <32 weeks of gestation without severe gastrointestinal complications to assess the impact of variations in nutritional supply during the first 2 weeks of life on the pulmonary outcome. Infants were grouped into no/mild and moderate/severe BPD to separate minor and major limitations in lung function.Results: After risk adjustment for gestational age, birth weight, sex, multiples, and antenatal steroids, a reduced total caloric intake and carbohydrate supply as the dominant energy source during the first 2 weeks of life prevailed statistically significant in infants developing moderate/severe BPD (p < 0.05). Enteral nutritional supply was increased at a slower rate with prolonged need for parenteral nutrition in the moderate/severe BPD group while breast milk provision and objective criteria of feeding intolerance were equally distributed in both groups.Conclusion: Early high caloric intake is correlated with a better pulmonary outcome in preterm infants <1,000 g. Our results are in line with the known strong impact of nutrient supply on somatic growth and psychomotor development. Our data encourage paying special attention to further decipher the ideal nutritional requirements for unrestricted lung development and promoting progressive enteral nutrition in the absence of objective criteria of feeding intolerance.

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The impact of vitamin D on fetal and neonatal lung maturation. A systematic review

AJP Lung Cellular and Molecular Physiology ◽

10.1152/ajplung.00117.2014 ◽

2015 ◽

Vol 308 (7) ◽

pp. L587-L602 ◽

Cited By ~ 54

Author(s):

Sine Lykkedegn ◽

Grith Lykke Sorensen ◽

Signe Sparre Beck-Nielsen ◽

Henrik Thybo Christesen

Keyword(s):

Vitamin D ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Bronchopulmonary Dysplasia ◽

Lung Development ◽

Distress Syndrome ◽

Hypovitaminosis D ◽

Laboratory Studies ◽

Lung Maturation ◽

The Impact

Respiratory distress syndrome (RDS) and bronchopulmonary dysplasia (BPD) are major complications to preterm birth. Hypovitaminosis D is prevalent in pregnancy. We systematically reviewed the evidence of the impact of vitamin D on lung development, surfactant synthesis, RDS, and BPD searching PubMed, Embase, and Cochrane databases with the terms vitamin D AND (surfactant OR lung maturation OR lung development OR respiratory distress syndrome OR fetal lung OR prematurity OR bronchopulmonary dysplasia). Three human studies, ten animal studies, two laboratory studies, and one combined animal and laboratory study were included. Human evidence was sparse, allowing no conclusions. BPD was not associated with vitamin D receptor polymorphism in a fully adjusted analysis. Animal and laboratory studies showed substantial positive effects of vitamin D on the alveolar type II cell, fibroblast proliferation, surfactant synthesis, and alveolarization. These data support the hypothesis of hypovitaminosis D as a frequent, modifiable risk factor of RDS and BPD, which should be tested in randomized controlled trials on pregnant women, those with threatening preterm delivery, or in the preterm neonates. Future experimental and human studies should aim to identify optimal time windows, vitamin D doses, and cut-off levels for 25-hydroxyvitamin D in interventions against RDS, BPD, and later adverse respiratory outcomes.

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The impact of oxygen therapy in preterm infants with bronchopulmonary dysplasia

10.1183/1393003.congress-2017.pa3857 ◽

2017 ◽

Author(s):

Cristina Tomacinschii ◽

Aliona Cotoman ◽

Svetlana Sciuca ◽

Rodica Selevestru ◽

Olesea Aioani

Keyword(s):

Preterm Infants ◽

Bronchopulmonary Dysplasia ◽

Oxygen Therapy ◽

The Impact

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The Impact of Postnatal Systemic Steroids on the Growth of Preterm Infants: A Multicenter Cohort Study

Nutrients ◽

10.3390/nu11112729 ◽

2019 ◽

Vol 11 (11) ◽

pp. 2729

Author(s):

Carlos Zozaya ◽

Alejandro Avila-Alvarez ◽

Fermín García-Muñoz Rodrigo ◽

María L. Couce ◽

Luis Arruza ◽

...

Keyword(s):

Cohort Study ◽

Preterm Infants ◽

Bronchopulmonary Dysplasia ◽

Invasive Mechanical Ventilation ◽

Postnatal Growth ◽

Linear Regression Models ◽

Multicenter Cohort Study ◽

Multicenter Cohort ◽

Major Congenital Malformations ◽

The Impact

Postnatal steroids, often used to prevent and treat bronchopulmonary dysplasia, may influence the growth of preterm infants, although data are scarce in the literature. This is a multicenter cohort study including surviving preterm infants <32 weeks at birth (n = 17,621) from the Spanish Neonatal Network SEN1500 database, without major congenital malformations. Linear regression models were adjusted for postnatal steroids, respiratory severity course (invasive mechanical ventilation at 28 days), progression to moderate–severe bronchopulmonary dysplasia (O2 at 36 weeks), length of stay, sex, gestational age and z-scores at birth. A subgroup analysis depending on the timing of administration, ventilation status at 28 days and moderate–severe BPD diagnosis was also performed. Overall, systemic postnatal steroids were not independently associated with poorer weight gain (0.1; 95% CI: −0.05 to 0.2 g/kg/day), linear growth (0; 95% CI: −0.03 to 0.01 cm/week) or head circumference growth (−0.01; 95% CI: −0.02 to 0 cm/week). Patients who received steroids after 28 days or who were not O2 dependent at 36 weeks after having received steroids gained more weight (0.22; 95% CI: 0.04 to 0.4 and 0.2; 95% CI: 0.004 to 0.5 g/kg/day, respectively). Globally, systemic postnatal steroids had no significant adjusted effect on postnatal growth.

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An Update on the Impact of Postnatal Systemic Corticosteroids on Mortality and Cerebral Palsy in Preterm Infants: Effect Modification by Risk of Bronchopulmonary Dysplasia

The Journal of Pediatrics ◽

10.1016/j.jpeds.2014.07.049 ◽

2014 ◽

Vol 165 (6) ◽

pp. 1258-1260 ◽

Cited By ~ 67

Author(s):

Lex W. Doyle ◽

Henry L. Halliday ◽

Richard A. Ehrenkranz ◽

Peter G. Davis ◽

John C. Sinclair

Keyword(s):

Cerebral Palsy ◽

Preterm Infants ◽

Bronchopulmonary Dysplasia ◽

Effect Modification ◽

Systemic Corticosteroids ◽

The Impact

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Introduction of a Quality Improvement Bundle Is Associated with Reduced Exposure to Mechanical Ventilation in Very Preterm Infants

Neonatology ◽

10.1159/000518392 ◽

2021 ◽

pp. 1-8

Author(s):

Stacey Chi-Yan Lo ◽

Risha Bhatia ◽

Calum T. Roberts

Keyword(s):

Mechanical Ventilation ◽

Quality Improvement ◽

Preterm Infants ◽

Demographic Data ◽

Neonatal Morbidity ◽

Very Preterm Infants ◽

Very Preterm ◽

Antenatal Steroids ◽

Cord Clamping ◽

The Impact

Introduction: Exposure to mechanical ventilation (MV) is a risk factor for bronchopulmonary dysplasia (BPD) in very preterm infants (VPTIs). We assessed the impact of a quality improvement (QI) bundle in VPTIs (<32 week gestation) on exposure to MV. Methods: We introduced a QI bundle consisting of deferred cord clamping (DCC), nasal bubble continuous positive airway pressure (bCPAP) in the delivery room (DR), and minimally invasive surfactant therapy (MIST). We compared respiratory outcomes and neonatal morbidity in historical pre-QI (July–December 2017) and prospective post-QI (February–July 2019) cohorts (QICs) of VPTIs. We pre-specified an adjusted analysis to account for the effects of gestational age, sex, antenatal steroids, and any demographic data that significantly differed between cohorts. Results: The pre-QI and post-QICs included 87 and 98 VPTIs, respectively. The post-QIC had decreased rates of MV in the DR (adjusted odds ratio [aOR] 0.26, 95% confidence interval [CI] 0.09–0.71), in the first 72 h of life (aOR 0.27, 95% CI 0.11–0.62) and during admission (aOR 0.28, 95% CI 0.12–0.66). Rates of BPD, combined BPD/death, and BPD severity were similar. The post-QIC was less likely to be discharged with home oxygen (aOR 0.27, 95% CI 0.08–0.91). Necrotising enterocolitis grade ≥2 increased (aOR 19.01, 95% CI 1.93–188.6) in the post-QIC. Conclusion: In this rapid-cycle QI study, implementation of a QI bundle consisting of DCC, early nasal bCPAP, and MIST in VPTIs was associated with reduced rates of MV in the DR, in the first 72 h of life and during admission, and reduced need for home oxygen.

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Follow-Up Examination at the Age of 15 Months of Extremely Preterm Infants after Postnatal Estradiol and Progesterone Replacement

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jcem.86.2.7176 ◽

2001 ◽

Vol 86 (2) ◽

pp. 601-603 ◽

Cited By ~ 27

Author(s):

Andreas Trotter ◽

Birgit Bokelmann ◽

Wolfgang Sorgo ◽

Doris Bechinger-Kornhuber ◽

Hilde Heinemann ◽

...

Keyword(s):

Pilot Study ◽

Preterm Infants ◽

Bone Mineralization ◽

Psychomotor Development ◽

Control Group ◽

Extremely Preterm ◽

Extremely Preterm Infants ◽

Developmental Index ◽

The Impact

A randomized controlled pilot study was performed with a sample of extremely preterm infants to evaluate the impact of postnatal estradiol and progesterone replacement on postnatal bone mineral accretion. Twenty-five of 30 infants in the pilot study survived, and of these, 24 infants were available for the follow-up examination at a median chronological age of 18.1 months (minimum-maximum, 17.0–20.6) corresponding to a corrected age of 14.8 months (minimum-maximum, 12.9–17.4). Somatic growth data and bone mineralization showed no differences between the hormone-treated and control group infants. The deviation of the skeletal age from the corrected age was 0.0 months (minimum-maximum, −7.7 to 7.4) for hormone-treated infants compared with −1.7 months (minimum-maximum, −7.5 to 5.9) for the control group. The Bayley scales mental and psychomotor developmental indexes were 89 (minimum-maximum, 71–107) and 101 (minimum-maximum, 49–121) for the hormone-treated infants and 93 (minimum-maximum, 49–111) and 71 (minimum-maximum, 49–121) for the control group infants, respectively (mental developmental index, P = 1.0; psychomotor developmental index, P = 0.14). The normal psychomotor development in the hormone-treated infants compared with the below average development in the control group infants is encouraging and indicates the potentially important integrative role of sex steroids for the developing brain. Larger studies on the effects of the postnatal replacement of estradiol and progesterone in extremely preterm infants are warranted.

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Predicting Long-Term Respiratory Outcomes in Premature Infants: Is It Time to Move beyond Bronchopulmonary Dysplasia?

Children ◽

10.3390/children7120283 ◽

2020 ◽

Vol 7 (12) ◽

pp. 283

Author(s):

Deepak Jain ◽

Alexander Feldman ◽

Subhasri Sangam

Keyword(s):

Preterm Infants ◽

Bronchopulmonary Dysplasia ◽

Respiratory Health ◽

Perinatal Care ◽

Factors Affecting ◽

Modifiable Factors ◽

Definition Of ◽

Respiratory Outcomes ◽

The Impact

Premature birth has been shown to be associated with adverse respiratory health in children and adults; children diagnosed with bronchopulmonary dysplasia (BPD) in infancy are at particularly high risk. Since its first description by Northway et al. about half a century ago, the definition of BPD has gone through several iterations reflecting the changes in the patient population, advancements in knowledge of lung development and injury, and improvements in perinatal care practices. One of the key benchmarks for optimally defining BPD has been the ability to predict long-term respiratory and health outcomes. This definition is needed by multiple stakeholders for hosts of reasons including: providing parents with some expectations for the future, to guide clinicians for developing longer term follow-up practices, to assist policy makers to allocate resources, and to support researchers involved in developing preventive or therapeutic strategies and designing studies with meaningful outcome measures. Long-term respiratory outcomes in preterm infants with BPD have shown variable results reflecting not only limitations of the current definition of BPD, but also potentially the impact of other prenatal, postnatal and childhood factors on the respiratory health. In this manuscript, we present an overview of the long-term respiratory outcomes in infants with BPD and discuss the role of other modifiable or non-modifiable factors affecting respiratory health in preterm infants. We will also discuss the limitations of using BPD as a predictor of respiratory morbidities and some of the recent advances in delineating the causes and severity of respiratory insufficiency in infants diagnosed with BPD.

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