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Effects of Inflammation on Growth Prior to the Diagnosis of Bronchopulmonary Dysplasia in Preterm Infants

Armbruster, Debra L.

Abstract Details

2009, Doctor of Philosophy, Ohio State University, Nursing.
Bronchopulmonary Dysplasia (BPD), defined as the need for oxygen at 28 days of life, is the most significant complication of neonatal Respiratory Distress Syndrome (RDS). Preterm infants with BPD develop a significant growth deficit early in the neonatal period. Nutrition is suboptimal during the acute phase of RDS; therefore, infants are undernourished at a crucial time for growth. Delivery of increased calories does not absolve the growth deficit. Neonatal lung disease is strongly associated with an inflammatory response which may influence metabolic rate and confound nutritional efforts to improve growth. The purpose of this study was to examine relationships among protein intake (gm/kg/d), growth velocity (gm/kg/d) and levels of an inflammatory mediator found in the urine, interleukin-1 receptor antagonist (IL-1ra), across the first four weeks of life. A case-comparison correlational design was used. Seventy six preterm infants born less than 30 weeks gestation requiring exogenous surfactant for RDS were recruited. Twenty-four enrolled infants who were transferred or developed positive blood cultures, or sepsis, during the 28 day study period were dis-enrolled from the study protocol. Preterm infants were enrolled by 48 hours of life. At 28 days of life the cohort was divided into two groups. Thirty seven infants who required oxygen for the 28 day period comprised the BPD group whereas 15 infants in room air at 28 days comprised the RDS group. Infants in the RDS group lost a significantly greater amount of weight prior to regaining birthweight, while infants in the BPD group initially lost significantly less weight, and required fewer days to regain birthweight. There were no significant differences for growth velocity between the two groups, but infants in the BPD group grew slower throughout the study period. Higher growth velocity during week one was correlated with greater growth velocity during week 4, therefore, early growth was found to potentiate overall growth. Infants in the BPD group received greater protein early but demonstrated slower growth by week 4 of the study period. In contrast, infants in the RDS group received less protein early but displayed greater growth velocity later in the study period. At 48 hours of life, both groups demonstrated an elevated inflammatory response. However, a significant and prolonged inflammatory response was evident across time for infants in the BPD group. It appears that preterm infants who are developing BPD sustained an inflammatory response through at least 28 days of life, while infants in the RDS group demonstrated a resolving inflammatory response during the 28 day period, and the difference in the response was significant between the two groups of preterm infants. Chronic inflammation is present in BPD. The effects on growth remain to be teased out. Clearly, the growth rate for the infants in the BPD group was slowing. This is important because this is occurring at a time when injured lungs need to heal and grow. This study needs to be replicated with a larger sample and a more qualitative evaluation of infant growth during the first few weeks of life.
Deborah Steward, PhD (Advisor)
Wendy Blakely (Committee Member)
Leif Nelin (Committee Member)
108 p.

Recommended Citations

Citations

  • Armbruster, D. L. (2009). Effects of Inflammation on Growth Prior to the Diagnosis of Bronchopulmonary Dysplasia in Preterm Infants [Doctoral dissertation, Ohio State University]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=osu1249490373

    APA Style (7th edition)

  • Armbruster, Debra. Effects of Inflammation on Growth Prior to the Diagnosis of Bronchopulmonary Dysplasia in Preterm Infants. 2009. Ohio State University, Doctoral dissertation. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=osu1249490373.

    MLA Style (8th edition)

  • Armbruster, Debra. "Effects of Inflammation on Growth Prior to the Diagnosis of Bronchopulmonary Dysplasia in Preterm Infants." Doctoral dissertation, Ohio State University, 2009. http://rave.ohiolink.edu/etdc/view?acc_num=osu1249490373

    Chicago Manual of Style (17th edition)