Determinants of Severe Metabolic Bone Disease in Very Low-Birth-Weight Infants with Severe Bronchopulmonary Dysplasia Admitted to a Tertiary Referral Center

Jensen, Erik A.; White, Ammie M.; Liu, Peihui; Yee, Keolamau; Waber, Brenda; Monk, Heather M.; Zhang, Huayan

doi:10.1055/s-0035-1560043

Cited by 23 publications

(10 citation statements)

References 28 publications

(29 reference statements)

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“…LOS remains an important problem and are associated with complications of preterm infants including BPD [27]. Jensen EA et al found that blood culture con rmed sepsis were associated with increased odds of severe MBD in infants with severe BPD [28]. Our study reenforced the association between LOS and MBD in BPD infants.…”

Section: Discussionsupporting

confidence: 70%

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Risk Factors of Metabolic Bone Disease in Bronchopulmonary Dysplasia Premature Infants With Gestational Age Less Than 32 Weeks

Chen

Zhang

Dai

et al. 2020

Preprint

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BackgroundMetabolic bone disease (MBD) is a complication of multifactorial aetiology in preterm infants. Several risk factors have been identified in general. Bronchopulmonary Dysplasia (BPD) infants present an increased incidence of MBD, but it is unknown which factors contribute to this. The aim of this study was to determine the risk factors for developing MBD in BPD infants.MethodsA retrospective review of the medical records of BPD infants admitted to the Neonatal Intensive Care Unit (NICU) at Zhangzhou Hospital between Jun 2016 and May 2020. BPD infants with MBD were identified, two contemporaneous without MBD matched by gestational age and gender were randomly selected as control infants for each case of MBD. The association between putative risk factors and MBD was estimated with ORs and 95% CIs. A P-value threshold ≤0.2 was used in univariate analysis for inclusion into a multivariate (adjusted) model with a P-value of < 0.05 as statistically significant.ResultsA total of 156 BPD infants were enrolled with 52 cases of MBD and 104 controls. Fetal growth restriction (OR 5.60, 95% CI, 1.77–17.72), extremely low birth weight (OR 3.70, 95% CI, 1.35–10.10), feeding volume ＜80 mL/kg/day at the end of the 4th week after birth (OR 12.21, 95% CI, 3.89–38.33), cholestasis (OR 4.29, 95% CI, 1.65–11.15), and late onset sepsis (OR 3.79, 95% CI, 1.12–12.77) were found to be statistically significant risk factors for MBD in BPD infants.ConclusionIn gestational age homogeneous BPD infants, fetal growth restriction, extremely low birth weight, feeding volume＜80 mL/kg/day at the end of the 4th week after birth and late onset sepsis are significant risk factors for MBD. These findings provide potential predictive factors for MBD in BPD infants but still warrant prospective validation.

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Section: Discussionsupporting

confidence: 70%

“…BPD infants have a higher incidence (60% vs 34%, compared with infants without BPD) of MBD in infants 1,250 g [2]. Among infants born 1,500 g suffered from severe BPD, about one third developed severe MBD [3].…”

Section: Introductionmentioning

confidence: 97%

Risk Factors of Metabolic Bone Disease in Bronchopulmonary Dysplasia Premature Infants With Gestational Age Less Than 32 Weeks

Chen

Zhang

Dai

et al. 2020

Preprint

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“…It has been reported that infants with bronchopulmonary dysplasia (BPD) have a higher incidence of MBD [2]. Among infants with birth weight < 1500 g suffered from severe BPD, about one third developed severe MBD [3].…”

Section: Introductionmentioning

confidence: 99%

Risk factors for metabolic bone disease among preterm infants less than 32 weeks gestation with Bronchopulmonary dysplasia

et al. 2021

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Background Bronchopulmonary dysplasia (BPD) infants present an increased incidence of metabolic bone disease (MBD), but it is unknown which factors contribute to this. The aim of this study was to determine the risk factors for developing MBD in BPD infants. Methods A retrospective review of the medical records of BPD infants admitted to the Neonatal intensive care unit at Zhangzhou Hospital between Jun 2016 and May 2020 was performed. BPD infants with MBD were identified, two contemporaneous without MBD matched by gestational age and gender were randomly selected as controls for each case of MBD. The association between putative risk factors and MBD was estimated with ORs and 95% CIs. A P-value threshold ≤0.2 was used in univariate analysis for inclusion into a multivariate (adjusted) model with a P-value of < 0.05 as statistically significant. Results A total of 156 BPD infants were enrolled with 52 cases of MBD and 104 controls. Fetal growth restriction (OR 6.00, 95% CI, 1.81–19.84), extremely low birth weight (OR 3.10, 95% CI, 1.07–8.94), feeding volume < 80 mL/kg/d at the end of the 4th week after birth (OR 14.98, 95% CI, 4.04–55.58), cholestasis (OR 4.44, 95% CI, 1.59–12.40), late onset sepsis (OR 3.95, 95% CI, 1.12–13.98) and prolonged (> 2 weeks) diuretics application (OR 5.45, 95% CI, 1.25–23.84) were found to be statistically significant risk factors for MBD in BPD infants. Conclusion In BPD infants of homogeneous gestational age, fetal growth restriction, extremely low birth weight, feeding volume < 80 mL/kg/d at the end of the 4th week after birth, cholestasis and late onset sepsis are significant risk factors for MBD. These findings provide potential predictive factors for MBD in BPD infants and warrant prospective validation.

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“…Long-term use of steroids and loop diuretics and limited mineral intake due to fluid restriction are recognized additional risk factors for metabolic bone disease in infants with BPD [ 95 ]. However, the ability of VLBW infants with early BPD to grow and accrete calcium was reported to be similar to that of those without early BPD [ 96 ].…”

Section: Nutritional Approach In the Prevention And Management Of Bpdmentioning

confidence: 99%

The Role of Nutrition in the Prevention and Management of Bronchopulmonary Dysplasia: A Literature Review and Clinical Approach

Rocha

Guimarães

Pereira‐da‐Silva

2021

IJERPH

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Bronchopulmonary dysplasia (BPD) remains the most common severe complication of preterm birth, and nutrition plays a crucial role in lung growth and repair. A practical nutritional approach for infants at risk of BPD or with established BPD is provided based on a comprehensive literature review. Ideally, infants with BPD should receive a fluid intake of not more than 135‒150 mL/kg/day and an energy intake of 120‒150 kcal/kg/day. Providing high energy in low volume remains a challenge and is the main cause of growth restriction in these infants. They need a nutritional strategy that encompasses early aggressive parenteral nutrition and the initiation of concentrated feedings of energy and nutrients. The order of priority is fortified mother’s own milk, followed by fortified donor milk and preterm enriched formulas. Functional nutrient supplements with a potential protective role against BPD are revisited, despite the limited evidence of their efficacy. Specialized nutritional strategies may be necessary to overcome difficulties common in BPD infants, such as gastroesophageal reflux and poorly coordinated feeding. Planning nutrition support after discharge requires a multidisciplinary approach to deal with multiple potential problems. Regular monitoring based on anthropometry and biochemical markers is needed to guide the nutritional intervention.

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Determinants of Severe Metabolic Bone Disease in Very Low-Birth-Weight Infants with Severe Bronchopulmonary Dysplasia Admitted to a Tertiary Referral Center

Abstract: Severe MBD was common in this referral-based cohort with severe BPD. The high incidence in this population is likely explained by the coexistence of multiple exposures and comorbidities associated with bone demineralization.

Cited by 23 publications

References 28 publications

Risk Factors of Metabolic Bone Disease in Bronchopulmonary Dysplasia Premature Infants With Gestational Age Less Than 32 Weeks

Risk Factors of Metabolic Bone Disease in Bronchopulmonary Dysplasia Premature Infants With Gestational Age Less Than 32 Weeks

Risk factors for metabolic bone disease among preterm infants less than 32 weeks gestation with Bronchopulmonary dysplasia

The Role of Nutrition in the Prevention and Management of Bronchopulmonary Dysplasia: A Literature Review and Clinical Approach

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