Nutrition Interventions for Children with Special Health Care Needs

Section 3 - Condition-Specific Nutrition Interventions
BPD/CLD show reduced rates of growth and reduced percentile ranking during the
first 1-2 years of life. Long-term follow-up, however, suggests that catch-up growth
from post-natal growth restriction may occur by age 3, or in the case of moderate to
severe BPD/CLD by 7-10 years of age (7,8,9).
Persistent hypoxemia is recognized as a cause of poor growth as well as feeding
problems in children with BPD (2,10,11). Inappropriate discontinuation of oxygen
therapy for these children has been reported to cause an abrupt drop in growth
rates. Maintaining adequate oxygenation improves growth (8). Infants with BPD who
are not on oxygen therapy may experience oxygen desaturation with feeding after
hospital discharge. Oxygen saturation should be assessed when growth falters or
when fatigue and aversive behaviors are observed during feeding (12,13,14).
Medications used in the management of BPD/CLD may contribute to feeding
intolerance, nutrient utilization, or nutrient needs. Through these interactions,
growth may be negatively impacted. Medications frequently used in the treatment
and management of BPD/CLD include diuretics, steroids, methylxanthines, and
bronchodialators. Many oral medications are hyperosmolar and when added to
feedings can contribute to nausea and feeding intolerance. Some medications may
increase metabolic rates and result in increased energy needs. Long term use of
steroids negatively impact linear growth and alter mineral status. Diuretics increase
urinary losses of electrolytes and calcium. A thorough history should include
medications and identify specific monitoring needs (8,13).
Growth faltering due to inadequate intake in infants with BPD/CLD has been
documented. Factors contributing to inadequate intake include feeding difficulties,
recurrent illness, and increased energy needs (3,8,9).
NuTRITIoNal SuppoRT
Nutrition is critical for prevention, treatment, and recovery from BPD/CLD.
Antioxidant nutritional therapies, including Vitamin A, Vitamin E, selenium and
n-acetylcysteine, have been proposed for the prevention of BPD. It has also been
proposed that inositol may aid in the prevention of BPD by enhancing the production
of surfactant (13). These therapies require further investigation. Recovery from BPD
occurs with growth of new lung tissue. Supportive therapy, therefore, depends on the
provision of adequate nutrients to support growth (2,5,13).
Higher energy needs have been proposed as a cause of growth failure in infants
with BPD/CLD. It has been suggested that infants with respiratory dysfunction may
experience increased energy expenditure associated with increased work of breathing
(WOB). Studies, however, have not demonstrated this consistently (13). Some
Nutrition Interventions for Children With Special Health Care Needs 179