Nutritional Management of Infants with Severe Bronchopulmonary Dysplasia During Acute Infection.

OBJECTIVE

To define nutritional provisions in infants admitted to the neonatal intensive care unit with severe bronchopulmonary dysplasia (sBPD) and concurrent diagnosis of infection.

STUDY

DESIGN

Fifty instances of infection over 4 years among 32 infants with sBPD were reviewed retrospectively from a level IV neonatal intensive care unit. Nutritional provisions (total daily energy and proportions from fat, carbohydrate, protein, and enteral feeds, as well as sodium, potassium, magnesium, phosphorous, calcium, acetate, and chloride) were assessed for 7 days prior to and after infection diagnosis and analyzed using general linear mixed models.

RESULTS

Across 50 total infections, nutritional provisions were similar before and after infection diagnosis. However, after diagnosis of a bloodstream infection (BSI; 12 infections), infants received a 28.4% increase in proportion of energy from fat (P = .0029) and 24% more chloride (P = .018) compared with before the BSI diagnosis. Infants after BSI diagnosis also received an 8.6% decrease in proportion of energy from carbohydrates (P = .049), 4.8% decrease in proportion of energy from protein (P = .049), 15.5% less potassium (P < .001), 26.7% less calcium (P = .001), and 18.9% less phosphorous (P = .0025).

CONCLUSIONS

In this cohort of infants with sBPD, nutritional provisions differed after the diagnosis of BSI, indicating that providers appear to manage the nutrition of acutely infected infants in a manner distinct from their management before diagnosis. These findings highlight how the biologic and clinical interactions between sBPD, infection, recovery, nutrition, and growth require further investigation.