Energy Expenditure in Premature Newborns with Bronchopulmonary Dysplasia

Abstract

Five premature newborns (birth weight, mean ± SD, 960 ± 145 g; gestational age 28 ± 1 weeks) with bronchopulmonary dysplasia (BPD) according to the criteria of Bancalari, and 6 controls (birth weight 1,320 ± 210 g; gestational age 30 ± 2 weeks) were studied for energy expenditure (EE) by indirect calorimetry. The measurement of total EE was performed when the intake of the infants in both groups was the same and when the respiratory condition had stabilized (control group: postnatal age 31 ± 6 days, 1,950 ± 200 g; BPD group: postnatal age 105 ± 45, postnatal weight 2,440 ± 380). The BPD group had a higher VO₂ (11.15 vs. 8.04 ml/kg/min, p < 0.01), VCO₂ (9.13 vs. 7.74 ml/kg/min, p < 0.02) and total EE (76 vs. 61 kcal/kg/day, p < 0.02). The highest values were encountered in the 3 more severely ill infants: mean VO₂ 11.03 ml/kg/min, mean EE 82 kcal/kg/min. In these cases, administration of medium chain triglycerides limits the increase in VCO₂ and lowers the respiratory quotient (0.87 vs. 0.96 in controls).

Heliox^® Tolerance in Spontaneously Breathing Neonates with Bronchopulmonary Dysplasia

“…Energy expenditure (EE) is then 25-30% higher than that measured in infants without chronic lung disease. This difference could at least partially explain growth retardation in BPD [1][2][3][4][5]. On the other hand, an increased energy supply might induce respiratory failure by increasing gas exchange [4,6].…”

Effects of Budesonide Inhalation on Energy Expenditure, Somatic Growth and Salivary Cortisol Levels in Preterm Infants with Chronic Lung Disease

“…There is ample evidence that CLD leads to decreased growth as an effect of decreased energy intake and increased energy utilization [10]. In the literature, the effects of CLD on EE in premature infants are still controversial.…”

“…In the literature, the effects of CLD on EE in premature infants are still controversial. Diversity in conclusions and interpretation resulted from different techniques of EE measurements (e.g., indirect calorimetry or double-labeled water method) and from an inhomogeneous study population of infants described in the reports [10, 23]. A number of studies have demonstrated elevated EE values in preterm infants with CLD caused by increased work of breathing and by the inflammatory process associated with respiratory distress syndrome [10, 11].…”

“…Diversity in conclusions and interpretation resulted from different techniques of EE measurements (e.g., indirect calorimetry or double-labeled water method) and from an inhomogeneous study population of infants described in the reports [10, 23]. A number of studies have demonstrated elevated EE values in preterm infants with CLD caused by increased work of breathing and by the inflammatory process associated with respiratory distress syndrome [10, 11]. We have previously reported that EE increases during the development of CLD in preterm infants [12], and our current clinical trial confirms and extends these findings, showing that EE was increased by 20% in both CLD groups at study entry and before BUD treatment when compared with the values of the healthy control group.…”

“…However, in humans, there is no evidence of an energy-sparing action of glucocorticoids. Very few studies [9] have assessed the metabolic effects of glucocorticoid therapy in CLD infants with respect to the questions of whether the use of glucocorticoids further increases EE caused by the respiratory disease itself [10,11,12], and whether it can influence rates of weight gain in this population.…”