The Role of Nutrition in the Prevention and Management of Bronchopulmonary Dysplasia: A Literature Review and Clinical Approach
Abstract
:1. Introduction
2. Aim
3. Literature Search
4. Fluid Management in Infants at Risk for and with Established BPD
5. Nutritional Requirements in Infants with BPD
6. Functional Nutrients with Potential Beneficial Effects on BPD
6.1. Polyunsaturated Fatty Acids
6.2. Amino Acids
6.3. Vitamins
6.4. Trace Elements
7. Nutritional Approach in the Prevention and Management of BPD
7.1. Parenteral Nutrition
7.2. Enteral Nutrition While in the Hospital
7.2.1. Enteral Nutrition Recommendations
7.2.2. Type of Feedings
Human Milk
Preterm Formulas
7.2.3. Timing of Initiation
7.2.4. Feeding Methods
7.2.5. Tracheostomy
7.3. Nutrition after Discharge
8. Monitoring
8.1. While in the Hospital
8.2. After Discharge
9. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
BPD | bronchopulmonary dysplasia |
BUN | blood urea nitrogen |
DHA | docosahexaenoic acid |
DHM | donor human milk |
ELBW | extremely low birth weight |
ESPGHAN | European Society for Paediatric Gastroenterology Hepatology and Nutrition |
GER | gastroesophageal reflux |
HM | human milk |
IVFEs | intravenous fat emulsions |
LA | linoleic acid |
MCT | medium-chain triglycerides |
MOM | mother’s own milk |
PMA | postmenstrual age |
VLBW | very low birth weight |
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Intervention | Reference | |
---|---|---|
Avoid excessive fluid intake |
| [32,33,34] |
Provide adequate incubator humidity |
| [37] |
Maintain adequate temperature |
| [38,39] |
Optimize early parenteral energy intake |
| [44,78] |
Optimize early parenteral amino acid intake |
| [79] |
Optimize early parenteral fat intake |
| [80] |
Provide adequate intravenous glucose |
| [33] |
Optimize early parenteral calcium and phosphorus intake |
| [86] |
Provide adequate intravenous lipid soluble vitamins |
| [90] |
Provide adequate intravenous trace elements |
| [91] |
Initiate early enteral feeding |
| [101,106,125] |
Intervention | Reference | |
---|---|---|
Fluid restriction | Less than 150 mL/kg/day Ideally, up to 135 mL/kg/day | [32,33,34] |
Optimize enteral energy intake | Ideally, 120–150 kcal/kg/day | [33,44] |
Optimize enteral protein intake |
| [92] |
Optimize enteral lipid intake |
| [92] |
Optimize enteral calcium and phosphate intake |
| [92] [97] |
Optimize sodium intake if diuretics are used |
| [12] |
Optimize enteral vitamin A intake | 400–1000 µg/kg/day or 1320–3300 IU/kg/day | [92] |
Optimize enteral vitamin E (α-tocopherol) intake | 2.2–11 mg/kg/day | [92] |
Supplemental iron | 4 mg/kg/day, from 4–8 postnatal weeks up to 12 months of life | [33] |
Parameter | Reference | |
---|---|---|
Body weight (daily) |
| [141] [146] |
Body length (weekly) | Body length velocity: 0.9–1.1 cm/week | [147] |
Head circumference (weekly) | Head circumference velocity: 0.9–1.0 cm/week | [147] |
Monitoring iron status | Complete blood count with reticulocyte count, and serum ferritin levels | [140] |
Monitoring protein nutrition | Blood urea nitrogen (BUN) | [113] |
Monitoring early metabolic bone disease | Serum phosphorus and alkaline phosphate levels | [149] |
Monitoring electrolyte balance (diuretics use) | Serum electrolytes | [27] |
Parameter | Reference | |
---|---|---|
Body weight, length, and head circumference | Intergrowth-21st standards: monitoring up to 64 weeks postmenstrual age, for infants born at >26 and <37 weeks of gestation | [150] |
Monitoring iron status | Complete blood count with reticulocyte count, and serum ferritin levels | [140] |
Monitoring protein nutrition | Blood urea nitrogen (BUN) | [113] |
Monitoring metabolic bone disease | Serum phosphorus and alkaline phosphate levels | [149] |
Monitoring electrolyte balance (if diuretic use) | Serum electrolytes | [27] |
Monitoring vitamins and trace elements (if deficiency suspicion) | Serum levels of vitamin A, 25-hydroxy vitamin D, zinc, and selenium | [27] |
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Rocha, G.; Guimarães, H.; Pereira-da-Silva, L. The Role of Nutrition in the Prevention and Management of Bronchopulmonary Dysplasia: A Literature Review and Clinical Approach. Int. J. Environ. Res. Public Health 2021, 18, 6245. https://doi.org/10.3390/ijerph18126245
Rocha G, Guimarães H, Pereira-da-Silva L. The Role of Nutrition in the Prevention and Management of Bronchopulmonary Dysplasia: A Literature Review and Clinical Approach. International Journal of Environmental Research and Public Health. 2021; 18(12):6245. https://doi.org/10.3390/ijerph18126245
Chicago/Turabian StyleRocha, Gustavo, Hercília Guimarães, and Luís Pereira-da-Silva. 2021. "The Role of Nutrition in the Prevention and Management of Bronchopulmonary Dysplasia: A Literature Review and Clinical Approach" International Journal of Environmental Research and Public Health 18, no. 12: 6245. https://doi.org/10.3390/ijerph18126245