Determinants of Severe Metabolic Bone Disease in Very Low-Birth-Weight Infants with Severe Bronchopulmonary Dysplasia Admitted to a Tertiary Referral Center.

OBJECTIVE: Nonrespiratory comorbidities are common among preterm infants with severe bronchopulmonary dysplasia (BPD) referred to tertiary perinatal centers. We evaluated the incidence, severity, and risk factors for metabolic bone disease (MBD) in this population. STUDY DESIGN: We conducted a retrospective cohort study of all infants born ≤ 1,500 g who were diagnosed with severe BPD in our single, tertiary referral center between September 2010 and October 2012. MBD severity was classified by serial radiography. RESULTS: Among the 83 infants diagnosed with severe BPD, 26 (31%) developed severe MBD (rickets). Male gender and lower gestational age and birth weight were associated with increased odds of severe MBD. After adjustment for these potential confounders, cytomegalovirus infection, postnatal growth restriction, surgical necrotizing enterocolitis, and blood culture confirmed sepsis were associated with increased odds of severe MBD. The cumulative duration of therapy with furosemide, hydrocortisone, and prednisolone each correlated with significantly greater probability of severe MBD. CONCLUSIONS: Severe MBD was common in this referral-based cohort with severe BPD. The high incidence in this population is likely explained by the coexistence of multiple exposures and comorbidities associated with bone demineralization.

A Comparison of Outcomes in Demand Versus Schedule Formula-Fed Premature Infants.

This qualitative short-term study was designed to determine if preterm infants who are fed in response to their own feeding cues, gain weight at a faster rate than infants fed on a schedule that may not correspond with these cues. Self-regulatory feeding behaviors have been studied by several previous investigators, and growing interest in neurobehavioral development of premature infants led to the hypothesis that ability to exhibit feeding cues is enhanced when premature infants are demand fed as opposed to being fed on a schedule. Furthermore, it was hypothesized that demand-fed premature infants may have a decreased length of stay when compared with schedule-fed infants. Results indicated that demand feeding may shorten hospital stay (31 days for the study group versus 33 days for the control group) and increase a premature infant's ability to exhibit feeding cues (demand-fed infants demonstrated and average of 10.5 feeding cues per day versus 4.6 feeding cues per day for the schedule-fed infants).