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Growth failure in infants with bronchopulmonary dysplasia: nutrition and elevated resting metabolic expenditure
S I Kurzner1, M Garg, D B Bautista
1Division of Neonatology and Pediatric Pulmonology, Childrens Hospital of Los Angeles, CA 90027.
Insights
Infants with bronchopulmonary dysplasia (BPD) and growth failure exhibit elevated metabolic demands and lower serum prealbumin levels. This suggests a state of protein-calorie malnutrition contributing to poor growth in these vulnerable infants.
Area of Science:
- Pediatric Pulmonology
- Neonatal Nutrition
- Growth and Development
Background:
- Bronchopulmonary dysplasia (BPD) is a chronic lung disease in infants, often associated with impaired growth.
- The precise mechanisms driving growth failure in BPD remain unclear, necessitating further investigation.
Purpose of the Study:
- To investigate the metabolic and nutritional factors contributing to growth failure in infants with BPD.
- To compare infants with BPD and growth failure to those with BPD and normal growth, and healthy controls.
Main Methods:
- Indirect calorimetry was used to measure resting metabolic expenditure in 13 infants with BPD and 12 healthy controls.
- Growth parameters, nutritional intake, stool analysis, and serum markers (albumin, cholesterol, glucose, prealbumin) were assessed.
- Infants with BPD were categorized based on growth failure (length/weight < 10th percentile).
Main Results:
- Seven of 13 infants with BPD experienced growth failure, characterized by lower birth weight and gestational age, and longer durations of respiratory support.
- No significant differences in dietary intake or stool/serum analyses were found between BPD subgroups, except for serum prealbumin.
- Elevated resting metabolic expenditure was observed in BPD infants with growth failure, inversely correlated with body weight. Serum prealbumin correlated positively with body weight.
Conclusions:
- Infants with BPD and growth failure demonstrate increased metabolic demands, contributing to their poor growth.
- Lower serum prealbumin levels in this group suggest a state of relative protein-calorie malnutrition.
- These findings highlight the need for targeted nutritional and metabolic support strategies for infants with BPD and growth failure.
Abstract:
The mechanisms underlying growth failure in infants with bronchopulmonary dysplasia are poorly understood. Thirteen infants with bronchopulmonary dysplasia at 6 months of corrected age and 12 full-term healthy control infants matched for age or size were studied. Resting oxygen consumption was measured during natural sleep, and an estimation of the resting metabolic expenditure by indirect calorimetry was performed. Growth parameters were measured, and a nutritional profile including dietary intake, stool analysis, and serum albumin, cholesterol, glucose, and prealbumin was obtained. Seven of the 13 infants with bronchopulmonary dysplasia had growth failure (defined as length and weight less than the tenth percentile of the Babson growth curves). These infants had lower birth weight, lower gestational age, and a greater number of days spent in supplemental oxygen or on mechanical ventilation. There was no statistical difference between the bronchopulmonary dysplasia-growth failure and bronchopulmonary dysplasia-normal growth infants for dietary intake or stool or serum analyses. However, serum prealbumin showed a significant linear correlation with body weight in infants with bronchopulmonary dysplasia. Resting metabolic expenditure was elevated in infants with bronchopulmonary dysplasia with growth failure and was inversely correlated with body weight in all infants with bronchopulmonary dysplasia. Thus, infants with bronchopulmonary dysplasia and growth failure have increased metabolic demands and decreased prealbumin values suggesting a relative state of protein-calorie malnutrition.