Special nutritional needs of infants for prevention of and recovery from bronchopulmonary dysplasia

Extremely low birth weight infants who develop severe respiratory disease m ay have special nutrient requirements imposed by a combination of enhanced utilization of nutrients or the need for epithelial cell repair resulting f rom the disease process, as well as to support catch-up growth, Inositol, f ree fatty acids, vitamin E and vitamin A are proposed as nutrients for whic h infants at risk of chronic pulmonary insufficiency may have special requi rements. Of these nutrients, only for vitamin A does suggestive evidence ex ist that high doses when given intramuscularly may reduce the incidence of death or chronic lung disease, Exogenous steroid therapy (dexamethasone), w hich is often used to improve pulmonary compliance in ventilated premature infants, may compromise vitamin A status and induce restricted somatic and bone mineral growth. Supplemental nutrition by means of enriched infant for mulas has provided benefits in growth and bone mass accretion to infants re covering from bronchopulmonary dysplasia up to 3-mo corrected age. This gro wth advantage was not sustained over the subsequent 9 mo, suggesting that p rolonged nutritional support is required until catch-up growth is complete. Further studies are required to delineate the needs for specific nutrients such as antioxidant vitamins and minerals or vitamin A that may play a rol e in preventing severe chronic lung disease in premature infants, As well, the role of supplemental nutrition (beyond the requirements of term infants ) to support catch-up growth and maintenance during the critical stages of early development requires further investigation before evidence-based nutr ient recommendations can be developed for this special population of infant s.