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Bott, L.1; Beghin, L.1; Devos, P.2; Pierrat, V.3; Guimber, D.1; Michaud, L.1; Turck, D.1; Gottrand, F.1
1Pediatrics, Jeanne de Flandre Lille University Children’s Hospital, 2Biostatistics, Lille University Faculty of Medicine, 3Neonatology, Jeanne de Flandre Lille University Children’s Hospital, Lille, France
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Introduction: Improved survival rates for extreme prematurity related to the progress of the neonatal intensive care have resulted in a corollary increase in incidence of bronchopulmonary dysplasia (BPD). Growth failure and lung sequelae are frequent events in BPD. We have studied long term nutritional status and its correlation with pulmonary function of children with BPD.
Methods: It was a monocentric transversal study of a cohort of 52 BPD children (22 girls and 30 boys). They were all born prematurely and suffered from BPD, and were 4 to 8-year-old at the time of the study. Malnutrition was defined as a Z score weight for height <-2 SD. Body composition was evaluated using dual-X-ray absorptiometry. Indirect calorimetry measured resting energy expenditure. Lung function test evaluated airways resistance, functional residual capacity and spirometry flow-volume curves.
Results: Thirty-five percents of the children with BDP were undernourished, with a predominance in girls (12 girls and 6 boys, p=0.009). Fat-mass, fat-free-mass and bone mineral density were significantly decreased in the undernourished group. Malnutrition occurred within the first months of life and was associated with a high resting energy expenditure despite increased caloric intakes. Under-nutrition was significantly associated with a low gestation age but not with pulmonary function. Multivariate analysis showed that factors significantly associated with under-nutrition were a low gestation age and under-nutrition at term and at the age of 2 years. Thirty-one children (60%) presented abnormal lung function tests. Obstruction was present in 16 patients, and distension was diagnosed in 14 patients. Multivariate analysis showed that malnutrition at the age of 2 years was the only risk factor to develop distension of the airways.
Conclusion: A significant proportion of children with BPD remained undernourished on long term follow-up. Pulmonary function at 4–8 years is associated with malnutrition in the first 2 years of life. Early nutritional interventions during the first months of life should be useful to prevent growth failure and improve pulmonary function at long term.
© 2004 Lippincott Williams & Wilkins, Inc.
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