Special nutritional needs of infants for prevention of and recovery from bronchopulmonary dysplasia.
Extremely low birth weight infants who develop severe respiratory disease may have special nutrient requirements imposed by a combination of enhanced utilization of nutrients or the need for epithelial cell repair resulting from the disease process, as well as to support catch-up growth. Inositol, free fatty acids, vitamin E and vitamin A are proposed as nutrients for which infants at risk of chronic pulmonary insufficiency may have special requirements. Of these nutrients, only for vitamin A does suggestive evidence exist that high doses when given intramuscularly may reduce the incidence of death or chronic lung disease. Exogenous steroid therapy (dexamethasone), which is often used to improve pulmonary compliance in ventilated premature infants, may compromise vitamin A status and induce restricted somatic and bone mineral growth. Supplemental nutrition by means of enriched infant formulas has provided benefits in growth and bone mass accretion to infants recovering from bronchopulmonary dysplasia up to 3-mo corrected age. This growth advantage was not sustained over the subsequent 9 mo, suggesting that prolonged nutritional support is required until catch-up growth is complete. Further studies are required to delineate the needs for specific nutrients such as antioxidant vitamins and minerals or vitamin A that may play a role in preventing severe chronic lung disease in premature infants. As well, the role of supplemental nutrition (beyond the requirements of term infants) to support catch-up growth and maintenance during the critical stages of early development requires further investigation before evidence-based nutrient recommendations can be developed for this special population of infants.
McMaster University, Department of Pediatrics, Faculty of Health Sciences, HSC 3V42, 1200 Main St. West, Hamilton, Ontario, Canada L8N 3Z5. satkins@fhs.mcmaster.ca
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Atkinson
D001997:Bronchopulmonary Dysplasia / Q000178:diet therapy* / Q000517:prevention & control; D002113:Calcification, Physiologic / Q000187:drug effects; D003907:Dexamethasone / Q000009:adverse effects / Q000494:pharmacology; D019587:Dietary Supplements; D005230:Fatty Acids, Nonesterified / Q000008:administration & dosage / Q000627:therapeutic use; D005526:Food, Formulated; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature / Q000254:growth & development*; D007294:Inositol / Q000008:administration & dosage / Q000627:therapeutic use; D009751:Nutritional Requirements; D014801:Vitamin A / Q000008:administration & dosage / Q000627:therapeutic use; D014810:Vitamin E / Q000008:administration & dosage / Q000627:therapeutic use
D005230:Fatty Acids, Nonesterified; D014801:Vitamin A; D014810:Vitamin E; D007294:Inositol; D003907:Dexamethasone