Bronchopulmonary dysplasia (BPD), abnormal development of the lung and air passages, in preterm infants results in growth failure and delayed skeletal mineralization. There are numerous contributing factors, which include: limited body stores at birth, medical treatment, inadequate intake and/or malabsorption of nutrients, and increased metabolic rate. Despite the lack of any controlled nutrition intervention studies on this population, current recommendations call tot supplemental energy being added to a standard infant formula.
This randomized, blinded intervention study of sixty infants with BPD evaluated the effects of two different isoenergetic infant formulas. One was composed of a standard formula with a high-energy supplement added (currently recommended formula) and the other was a formula enriched with minerals and had a higher protein-to-energy ratio. The study was initiated when infants were stabile, growing and receiving full oral reeds. Urine and fecal analysis was performed, and anthropometry was assessed using dual energy X-ray absorptometry (DXA).
Four infants in the enriched formula study group dropped out for health reasons or at the parents' request. Baseline measures were similar between groups. At I and 3 months into study protocol, formula and energy intake were similar between groups. Infants in the enriched formula group had greater intake of protein, calcium, phosphorous, and zinc. The higher osmolality of the enriched formula did not appear to affect tolerance, since reflux occurred in 10 infants consuming the standard formula and only 5 infants consuming the enriched formula. At 3 months, infants fed the enriched formula were significantly longer than the other infant group. There was no difference between groups for weight and head circumference. Bone mineral accretion was significantly higher for infants consuming the enriched formula at 3 months.
The study suggests that a formula enriched with protein, zinc, phosphorous, and calcium will help accelerate growth in infants with bronchopulmonary dysplasia. The authors note that additional study is required to determine whether early aggressive nutrition intervention is warranted on BPD infants, and to determine if and when catch-up growth in BPD infants occurs.
Janet A. Brunton, Saroj Saigal, and Stephanie A. Atkinson, 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, The Journal of Pediatrics, 133:340-345 (September 1998) [Correspondence: Stephanie Atkinson, PhD, Professor, Department of Pediatrics, HSC 3V42, McMaster University, 1200 Main St. West, Hamilton, ON, L8N 3Z5 Canada]
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