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Preventing Bronchopulmonary Dysplasia Through Nutrition in Preterm Infants: A Systematic Review of the Literature
Domenico Umberto De Rose1, Nadia Liotto2, Elena Maggiora3,4
1Neonatal Intensive Care Unit, "Bambino Gesù" Children's Hospital, IRCCS, 00165 Rome, Italy.
Insights
Optimizing nutrition for preterm infants, including parenteral nutrition and mother's milk, may reduce bronchopulmonary dysplasia (BPD) risk. Further research is needed to confirm effectiveness and guide clinical practice for this chronic lung disease.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Nutritional Science
Background:
- Bronchopulmonary dysplasia (BPD) is a significant chronic lung disease in preterm infants.
- Nutritional practices are increasingly recognized as potential preventative strategies for BPD.
Purpose of the Study:
- To systematically review the literature on nutritional interventions for preventing BPD in preterm infants.
- To identify evidence-based nutritional strategies that may reduce BPD incidence.
Main Methods:
- Systematic review of studies published before March 3, 2024, using PubMed, Cochrane Library, and CINAHL.
- Inclusion of studies on preterm infants (<37 weeks gestation) examining nutritional interventions and BPD outcomes.
- Categorization of 135 included studies by nutritional intervention type (parenteral, enteral, supplements) and quality assessment.
Main Results:
- Early optimization of fluid, energy, and nutrient intake via parenteral nutrition shows promise.
- Early enteral feeding and maternal milk consumption, in a dose-dependent manner, appear to reduce BPD risk.
- The quality of evidence across studies was variable.
Conclusions:
- Nutritional interventions, alongside intensive and respiratory care, may help minimize BPD risk in preterm infants.
- Evidence for certain nutritional strategies is inconclusive, highlighting the need for more robust research.
- Well-designed studies are crucial to confirm the efficacy of specific nutritional interventions for BPD prevention.
Context:
Bronchopulmonary dysplasia (BPD) is a multifactorial, chronic lung disease affecting preterm infants. Several interventions have been proposed to prevent BPD; a role for specific nutritional practices has also been suggested.
Objective:
To evaluate, by means of a systematic review of the available literature, which nutritional interventions might prevent BPD in preterm infants.
Data Sources:
PubMed, The Cochrane Library, and CINAHL were searched using a predefined PICO/PECO strategy for studies recruiting preterm infants (gestational age <37 weeks), examining nutritional interventions, and reporting on BPD. No study design limitation was applied. Articles were included if written in English and published before March 3, 2024.
Data Extraction:
The literature search yielded 1825 results. After screening, removal of duplicates, and retrieval of additional papers by hand-searching, 135 papers were included in the systematic review and categorized according to their main topic (parenteral nutrition, enteral nutrition, and nutritional supplements). Study quality assessment was performed using the criteria set out by the Cochrane Handbook for Systematic Reviews of Interventions.
Data Analysis:
Several nutritional interventions appear to reduce the risk of BPD in preterm infants. These include early optimization and balance of fluid, energy, and nutrient intakes through parenteral nutrition, early enteral feeding, and use of own mother's milk in a dose-dependent fashion. The quality of the examined literature was mixed.
Conclusion:
The available literature suggests that several nutritional interventions could play a role, together with intensive and respiratory care, to minimize the risk of chronic lung disease in preterm infants. However, the evidence for some interventions is inconclusive and deserves additional, well-designed research.
Systematic Review Registration:
PROSPERO registration no. CRD42022300524.
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