Elsevier

The Journal of Pediatrics

Volume 133, Issue 3, September 1998, Pages 340-345
The Journal of Pediatrics

Growth and body composition in infants with bronchopulmonary dysplasia up to 3 months corrected age: A randomized trial of a high-energy nutrient-enriched formula fed after hospital discharge,☆☆,,★★

https://doi.org/10.1016/S0022-3476(98)70266-5Get rights and content

Abstract

Objectives: (1) To determine whether nutrient malabsorption or inadequate nutrient intake were involved in the cause of growth delay in patients with bronchopulmonary dysplasia, and (2) to determine whether a nutrient-enriched formula given to infants with bronchopulmonary dysplasia to 3 months corrected age improves the rate of growth with greater lean and bone mass accretion when compared with infants fed an isoenergetic standard infant formula.

Study design: A blinded, nutrition intervention trial of 60 preterm infants with bronchopulmonary dysplasia (birth weight, 866 ± 169 g, gestational age, 26 ± 1.5 weeks) randomized to either nutrient-enriched formula or standard formula. Growth, body composition, and nutrient retention were compared between groups by Student’s t tests and analysis of covariance.

Results: Infants fed the enriched formula had significantly greater nitrogen and mineral retention at 38 weeks’ postmenstrual age, and only the infants fed enriched formula had zinc retention similar to the intrauterine accretion. At 3 months corrected age infants fed enriched formula attained greater length (P < .05), greater radial bone mineral content (P < .01), and greater lean mass (P < .01). The male infants in the enriched formula group had greater whole body bone mineral content than did male infants in the standard formula group (P = .02).

Conclusions: Greater linear growth and lean and bone mass in the enriched formula group suggests that infants with bronchopulmonary dysplasia attain faster “catch-up” growth when fed higher intakes of protein, calcium, phosphorus, and zinc than provided in standard proprietary formulas. (J Pediatr 1998;133:340-5)

Section snippets

Patients and Methods

Infants were recruited from the Neonatal Intensive Care Units at The Children’s Hospital, Hamilton Health Sciences Corporation and St. Joseph’s Hospital, Hamilton, Ontario, between January 1991 and November 1994. The study was approved by the Research Project Advisory Committees at both hospitals. Eligible infants weighed <1500 g at birth and were appropriate for gestational age, had BPD, were formula fed by parental choice, had no major congenital anomalies, and had not undergone

Results

Thirty infants were randomized to each of the 2 nutritional interventions (SF, 13 male infants; EF, 18 male infants). Four infants in the EF group dropped out after term age because of unfounded lactose intolerance, parental request, recurrent excoriated buttocks, or death from respiratory complications. The infants in the SF and EF groups were similar in birth weight (866 ± 169 g), gestational age (26.0 ± 1.5 weeks), days ventilated (38 ± 18), total cumulative steroid dose (about 6.2 mg/kg

Discussion

This randomized blinded study documented accelerated growth in infants with BPD in response to a protein-, mineral-, and energy-enriched formula provided after discharge from hospital. The period of most improved growth was from approximately 37 weeks’ PMA to 1 month CA. The standard term infant formulas commonly used after discharge, even if supplemented with energy, will not support the growth potential that was observed in the infants who were fed EF.

Enhanced growth with feeding of an

Acknowledgements

We are grateful to the families and the infants who participated in this study and to Michelle Whelan, RN, for her skill in acquiring measurements of infants. We are also appreciative of the staff of the Growth and Development Clinic at the Children’s Hospital for assisting in the timely follow-up of the infants in this study. Individual group data for all outcomes measured are available from the authors on request.

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  • Cited by (0)

    From the Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.

    ☆☆

    Funded by a grant from the Ontario Ministry of Health, with formula manufactured to investigators’ specifications and donated by Wyeth-Ayerst Int., Radnor, Pennsylvania.

    Reprint requests: Stephanie Atkinson, PhD, Professor, Department of Pediatrics, HSC 3V42, McMaster University, 1200 Main St. West, Hamilton, Ontario, Canada L8N 3Z5.

    ★★

    0022-3476/98/$5.00 + 0  9/21/89554

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