Enteral Feeding/Total Fluid Intake Ratio Is Associated With Risk of Bronchopulmonary Dysplasia in Extremely Preterm Infants

Lin, Bingchun; Xiong, Xiaoxing; Lu, Xin-Jiang; Zhao, Jie; Huang, Zhifeng; Chen, Xueyu

doi:10.3389/fped.2022.899785

Cited by 4 publications

(7 citation statements)

References 23 publications

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“…Retrospective studies by Wemhöner et al [ 13 ] and Uberos et al [ 14 ] revealed that preterm infants who developed BPD received less enteral feed. According to a recent study by Lin et al [ 15 ], a 10% increase in the enteral feeding/total fluid intake ratio dramatically decreased the incidence of BPD by 55.6% during the second week.…”

Section: Discussionmentioning

confidence: 99%

Nutritional support during the first week for infants with bronchopulmonary dysplasia and respiratory distress: a multicenter cohort study in China

Lin,

Bai,

et al. 2024

BMC Pediatr

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Background Bronchopulmonary dysplasia (BPD) is a major complication affecting the survival rate and long-term outcomes of preterm infants. A large, prospective, multicenter cohort study was conducted to evaluate early nutritional support during the first week of life for preterm infants with a gestational age < 32 weeks and to verify nutritional risk factors related to BPD development. Methods A prospective multicenter cohort study of very preterm infants was conducted in 40 tertiary neonatal intensive care units across mainland China between January 1, 2020, and December 31, 2021. Preterm infants who were born at a gestational age < 32 weeks, < 72 h after birth and had a respiratory score > 4 were enrolled. Antenatal and postnatal information focusing on nutritional parameters was collected through medical systems. Statistical analyses were also performed to identify BPD risk factors. Results The primary outcomes were BPD and severity at 36 weeks postmenstrual age. A total of 1410 preterm infants were enrolled in this study. After applying the exclusion criteria, the remaining 1286 infants were included in this analysis; 614 (47.7%) infants were in the BPD group, and 672 (52.3%) were in the non-BPD group. In multivariate logistic regression model, the following six factors were identified of BPD: birth weight (OR 0.99, 95% CI 0.99–0.99; p = 0.039), day of full enteral nutrition (OR 1.03, 95% CI 1.02–1.04; p < 0.001), parenteral protein > 3.5 g/kg/d during the first week (OR 1.65, 95% CI 1.25–2.17; p < 0.001), feeding type (formula: OR 3.48, 95% CI 2.21–5.49; p < 0.001, mixed feed: OR 1.92, 95% CI 1.36–2.70; p < 0.001; breast milk as reference), hsPDA (OR 1.98, 95% CI 1.44–2.73; p < 0.001), and EUGR ats 36 weeks (OR 1.40, 95% CI 1.02–1.91; p = 0.035). Conclusions A longer duration to achieve full enteral nutrition in very preterm infants was associated with increased BPD development. Breastfeeding was demonstrated to have a protective effect against BPD. Early and rapidly progressive enteral nutrition and breastfeeding should be promoted in very preterm infants. Trial registration The trial was registered in the Chinese Clinical Trial Registry (No. ChiCTR2000030125 on 24/02/2020) and in www.ncrcch.org (No. ISRCTN84167642 on 25/02/2020).

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Section: Discussionmentioning

confidence: 99%

Nutritional support during the first week for infants with bronchopulmonary dysplasia and respiratory distress: a multicenter cohort study in China

Lin,

Bai,

et al. 2024

BMC Pediatr

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“…A collective of 8 papers incorporated in this analysis [5,[7][8][9][10][11][12][13][14] presented the total calorie intake data for children during the postnatal week, revealing heterogeneity (I 2 = 61%, p = 0.009). Consequently, a sensitivity analysis was conducted, revealing that Xu 2023 was the primary factor contributing to the heterogeneity, potentially attributed to the reliance on parenteral calorie intake as the predominant feeding method in this particular literature.…”

Section: Calorie Intakementioning

confidence: 99%

“…The comprehensive assessment of the 10 incorporated research articles involved 1325 participants, encompassing 644 subjects diagnosed with BPD and 681 without BPD. The inclusive selection comprised four case-control studies [5][6][7][8] and six cohort studies [9][10][11][12][13][14]. Detailed information, including the essential characteristics and evaluation scores based on the NOS, is presented in Table 1.…”

Section: Basic Characteristics and Quality Assessment Of Included Stu...mentioning

confidence: 99%

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Nutrition and fluid management at 1 week postnatally and the risk of bronchopulmonary dysplasia in preterm infants: A Meta-Analysis

Yang,

Mei,

Huo

et al. 2023

Preprint

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OBJECTIVE To explore the intricate interplay between nutritional status, fluid management in the early postnatal phase of preterm infants, and the susceptibility to bronchopulmonary dysplasia (BPD). METHODS A meticulous review encompassing PubMed, Embase, Cochrane Library, Web of Science, Chinese Biomedical Literature Database, China Knowledge Network, Wanfang Database, and Wipu Database was conducted. The search spanned up to October 7, 2023, focusing on case-control and cohort studies delving into the nexus of nutritional management and BPD. Meta-analysis, employing RevMan 5.3 and Stata 15.0 software, was carried out to synthesize the findings. RESULTS Incorporating 10 studies with a total of 1325 subjects (644 with BPD and 681 normal control), our meta-analysis revealed a significant reduction in calorie intake during the 1st week postnatally in the BPD group compared to the non-BPD group (MD = -5.94, 95% CI: -7.38 to -4.51, P < 0.05). Although fluid loading in both groups exhibited no statistical significance (MD = 5.83, 95% CI: -1.37-13.03, P = 0.11 > 0.05), macronutrient disparities were evident in the BPD group. Protein (MD = -0.13, 95% CI: -0.22 to -0.04, P < 0.05), lipids (MD = -0.39, 95% CI: -0.49 to -0.299,, P < 0.05), and carbohydrates (MD = -0.74, 95% CI: -0.95 to -0.54, P < 0.05) in the BPD group exhibited significantly lower intake during the initial postnatal week. Moreover, the BPD group experienced a prolonged time to achieve complete enteral nutrition compared to the non-BPD group (MD = 9.71, 95% CI: 7.78–11.63, P < 0.05). CONCLUSION Insufficient early nutritional intake may correlate with heightened BPD risk. Vigilant attention to nutritional and fluid management, coupled with optimization of respiratory support protocols, is imperative to mitigate BPD incidence.

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“…Insufficient nutritional intake in the first weeks of life can produce long-lasting damage to lung development, maturation and repair in extremely preterm infants, in whom alveolisation of the lung occurs mostly or entirely after birth (16) . The latter authors have also reported that a higher ratio of enteral volume received to total fluid intake in the second week of life is associated with a lower risk of BPD in extremely preterm infants.…”

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confidence: 99%

Breast-feeding as protective factor against bronchopulmonary dysplasia in preterm infants

Uberos,

Sanchez-Ruiz,

Fernández-Marin

et al. 2024

Br J Nutr

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Breastfeeding is associated with fewer comorbidities in very low birth weight (VLBW) preterm infants. Bronchopulmonary dysplasia (BPD) of VLBW infants is a multifactorial pathology in which nutritional aspects may be of special importance. The aim of this study is to determine, in a cohort of VLBW infants, whether breast milk nutrition is associated with a reduced prevalence and severity of BPD. A retrospective study was conducted to record the intake of mother’s own milk (MOM), pasteurised donor human milk (DHM) or preterm formula milk in the first two weeks of postnatal life of 566 VLBW newborns at our hospital during the period January 2008 – December 2021. After applying the relevant exclusion criteria, data for 489 VLBW infants were analysed; 195 developed some degree of BPD. Moderate or severe BPD is associated with less weight gain. Moreover, the preferential ingestion of breast milk in the first and second postnatal weeks had effects associated with lower OR for BPD, which were statistically demonstrable for mild (OR 0.16; 95% CI 0.03 – 0.71) and severe (OR 0.08; 95% CI 0.009 – 0.91) BPD. Breastfeeding during the first weeks of postnatal life is associated with a reduced prevalence of BPD which is frequently associated with less weight gain as a result of greater respiratory effort with greater energy expenditure.

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Enteral Feeding/Total Fluid Intake Ratio Is Associated With Risk of Bronchopulmonary Dysplasia in Extremely Preterm Infants

Cited by 4 publications

References 23 publications

Nutritional support during the first week for infants with bronchopulmonary dysplasia and respiratory distress: a multicenter cohort study in China

Nutritional support during the first week for infants with bronchopulmonary dysplasia and respiratory distress: a multicenter cohort study in China

Nutrition and fluid management at 1 week postnatally and the risk of bronchopulmonary dysplasia in preterm infants: A Meta-Analysis

Breast-feeding as protective factor against bronchopulmonary dysplasia in preterm infants

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