Nutrition Interventions for Children with Special Health Care Needs

Chapter 16 - Nutrition Interventions for Respiratory Diseases
of BPD due to lung injury, particularly in the larger more mature infant, a “new
BPD” has been described consistent with an arrest of pulmonary development and
disruption of alveolarization (2-5).
The classic diagnosis of BPD may be assigned at 28 days of life if the following
criteria are met (6):
• Positive pressure ventilation during the first 2 weeks of life for a minimum of 3
days
• Clinical signs of abnormal respiratory function
• Requirement for supplemental oxygen for longer than 28 days of age to maintain
PaO2 (partial pressure of oxygen, a measure of arterial oxygen tension) above 50
mm Hg
• Chest radiograph with diffuse abnormal findings of BPD
Dissatisfaction with the definition and diagnostic criteria to describe BPD resulted in
the National Institute of Child Health and Human Development/National Heart, Lung
and Blood Institute expanding the definition to reflect differing criteria for infants less
than or greater than 32 weeks gestation. This expanded definition includes different
diagnostic criteria for mild, moderate, and severe disease and recognizes that BPD
represents a continuum of lung disease (3,4,6). It has been suggested that the term
“chronic lung disease of infancy” (CLD) be used to describe infants who continue to
have significant pulmonary dysfunction at 36 weeks gestational age (GA). In current
clinical practice, these terms are often not clearly differentiated, but infants with
significant pulmonary dysfunction at 36 weeks GA are likely to be those who require
ongoing nutritional support after initial hospital discharge.
This chapter will cover concerns that are specific to the infant with chronic pulmonary
dysfunction (BPD/CLD).
Growth and Nutritional Support
The overall goal for infants with BPD/CLD is to promote growth and development. As
infants grow, lung function improves and risk of severe cardiopulmonary sequelae,
morbidity, and mortality with respiratory infection declines. Cornerstones of
treatment are pulmonary support to maintain optimal oxygen saturation and prevent
complications and nutrition support to promote growth.
GRowTh
Growth in infants and young children with BPD may be compromised by several
factors. These include respiratory limitations, altered nutrient needs, drug-nutrient
interactions, and feeding difficulties. Documented studies of growth in patients with
178 Nutrition Interventions for Children With Special Health Care Needs