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Nutritional Management of Infants with Severe Bronchopulmonary Dysplasia During Acute Infection
Kristina Thompsen1, Karna Murthy2, Daniel T Robinson1
1Division of Neonatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Feinberg School of Medicine at Northwestern University, Chicago, IL.
Insights
Nutritional support for infants with severe bronchopulmonary dysplasia (sBPD) and infection changed after bloodstream infection (BSI) diagnosis. Fat and chloride increased, while carbohydrates, protein, potassium, calcium, and phosphorus decreased.
Area of Science:
- Neonatal intensive care
- Pediatric nutrition
- Infectious disease in neonates
Background:
- Severe bronchopulmonary dysplasia (sBPD) is a chronic lung disease in premature infants.
- Infection is a common complication in infants with sBPD, impacting their nutritional needs.
- Understanding nutritional management during infection is critical for growth and recovery.
Purpose of the Study:
- To define nutritional provisions in infants with sBPD and concurrent infection.
- To analyze changes in nutritional intake before and after infection diagnosis in this vulnerable population.
Main Methods:
- Retrospective review of 32 infants with sBPD and 50 infection instances over 4 years.
- Assessment of daily energy intake and macronutrient/electrolyte composition for 7 days pre- and post-infection diagnosis.
- Analysis using general linear mixed models to identify significant changes.
Main Results:
- Overall nutritional provisions did not significantly change across all infections.
- Following bloodstream infection (BSI) diagnosis, infants received increased energy from fat and chloride.
- Concurrently, carbohydrate, protein, potassium, calcium, and phosphorus intake decreased post-BSI diagnosis.
Conclusions:
- Nutritional management strategies appear to adapt following BSI diagnosis in infants with sBPD.
- These findings suggest distinct nutritional approaches for acutely infected neonates.
- Further research is needed to explore the complex interplay between sBPD, infection, nutrition, and growth.
Objective:
To define nutritional provisions in infants admitted to the neonatal intensive care unit with severe bronchopulmonary dysplasia (sBPD) and concurrent diagnosis of infection.
Study Design:
Fifty instances of infection over 4 years among 32 infants with sBPD were reviewed retrospectively from a level IV neonatal intensive care unit. Nutritional provisions (total daily energy and proportions from fat, carbohydrate, protein, and enteral feeds, as well as sodium, potassium, magnesium, phosphorous, calcium, acetate, and chloride) were assessed for 7 days prior to and after infection diagnosis and analyzed using general linear mixed models.
Results:
Across 50 total infections, nutritional provisions were similar before and after infection diagnosis. However, after diagnosis of a bloodstream infection (BSI; 12 infections), infants received a 28.4% increase in proportion of energy from fat (P = .0029) and 24% more chloride (P = .018) compared with before the BSI diagnosis. Infants after BSI diagnosis also received an 8.6% decrease in proportion of energy from carbohydrates (P = .049), 4.8% decrease in proportion of energy from protein (P = .049), 15.5% less potassium (P < .001), 26.7% less calcium (P = .001), and 18.9% less phosphorous (P = .0025).
Conclusions:
In this cohort of infants with sBPD, nutritional provisions differed after the diagnosis of BSI, indicating that providers appear to manage the nutrition of acutely infected infants in a manner distinct from their management before diagnosis. These findings highlight how the biologic and clinical interactions between sBPD, infection, recovery, nutrition, and growth require further investigation.
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