title: The role of nutrition in promoting growth in pre-term infants with bronchopulmonary dysplasia: a prospective non-randomised interventional cohort study.
abstract: BACKGROUND
  Pre-term infants who develop bronchopulmonary dysplasia (BPD) are at risk of postnatal growth failure. It has been reported that energy expenditure is higher in infants with BPD than in those without BPD. The aim of the study was to evaluate whether increasing the enteral energy intake of pre-term infants with BPD can improve post-natal growth.
  
  
  METHODS
  This prospective, non-randomised interventional cohort study was designed to assess growth in 57 preterm infants with BPD (gestational age <32 weeks, birth weight <1500 g, and persistent oxygen dependency for up to 28 days of life) fed individually tailored fortified breast milk and/or preterm formula, and a historical control group of 73 pre-term infants with BPD fed breast milk fortified in accordance with the instructions of the manufacturer and/or pre-term formula. Between-group differences in the continuous variables were analysed using Student's t test or the Mann-Whitney test; the discrete variables were compared using the chi-squared test. Linear regression analysis was used to investigate the independent contribution of enteral energy intake to weight gain velocity.
  
  
  RESULTS
  The duration of parenteral nutrition was similar in the historical and intervention groups (43.7 ± 30.9 vs 39.6 ± 17.4 days). After the withdrawal of parenteral nutrition, enteral energy intake was higher in the infants in the intervention group with mild or moderate BPD (131 ± 6.3 vs 111 ± 4.6 kcal/kg/day; p < 0.0001) and in those with severe BPD (126 ± 5.3 vs 105 ± 5.1 kcal/kg/day; p < 0.0001), whereas enteral protein intake was similar (3.2 ± 0.27 vs 3.1 ± 0.23 g/kg/day).Weight gain velocity was greater in the infants in the intervention group with mild or moderate BPD (14.7 ± 1.38 vs 11.5 ± 2 g/kg/day, p < 0.0001) and in those with severe BPD (11.9 ± 2.9 vs 8.9 ± 2.3 g/kg/day; p < 0.007). The percentage of infants with post-natal growth retardation at 36 weeks of gestational age was higher in the historical group (75.3 vs 47.4; p = 0.02).
  
  
  CONCLUSIONS
  On the basis of the above findings, it seems that improved nutritional management promotes post-natal ponderal growth in pre-term infants with BPD.
authors.affiliation: NICU, Department of Clinical Sciences and Community Health, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Via Commenda 12, 20122 Milan, Italy. maria.gianni@unimi.it.
authors.forename: Maria Lorella
authors.initials: ML
authors.lastname: Giannì
authors.forename: Paola
authors.initials: P
authors.lastname: Roggero
authors.forename: Maria Rosa
authors.initials: MR
authors.lastname: Colnaghi
authors.forename: Pasqua
authors.initials: P
authors.lastname: Piemontese
authors.forename: Orsola
authors.initials: O
authors.lastname: Amato
authors.forename: Anna
authors.initials: A
authors.lastname: Orsi
authors.forename: Laura
authors.initials: L
authors.lastname: Morlacchi
authors.forename: Fabio
authors.initials: F
authors.lastname: Mosca
mesh_terms: D001997:Bronchopulmonary Dysplasia / Q000178:diet therapy*; D002149:Energy Intake; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D005527:Food, Fortified; D006801:Humans; D041943:Infant Formula; D007227:Infant Nutritional Physiological Phenomena; D007231:Infant, Newborn; D007234:Infant, Premature / Q000254:growth & development*; D016014:Linear Models; D008297:Male; D008895:Milk, Human; D011446:Prospective Studies; D016896:Treatment Outcome; D015430:Weight Gain