Nutrition in an evolving/established CLD

[Mo7]

I'm seeking advice and insights from others on the following issue:

How do you manage a four-week-old premature baby with evolving or established chronic lung disease (CLD) who is still on invasive ventilation or non-invasive ventilation (NIV) and requires a significant amount of FiO2 (>40%)?

The baby's weight gain has been poor, necessitating an increase in the total fluid intake (TFI) up to 180ml/kg/day of Mom Own Milk (MOM) and fortifiers, as well as the use of diuretics.

In my experience, and based on most cases of CLD, these infants benefit from fluid restriction (<150ml/kg/day), which typically leads to a reduction in oxygen requirements. I usually supplement nutrition by adding preterm formula or high-energy formula to the TFI. However, I'm wondering if there are other ways to increase the nutritional value of (MOM+F) without using formula milk. adding Proteins?

Thanks,

Mo7

 

 

[Rao]

On 5/6/2023 at 9:36 AM, Mo7 said:

I'm seeking advice and insights from others on the following issue:

How do you manage a four-week-old premature baby with evolving or established chronic lung disease (CLD) who is still on invasive ventilation or non-invasive ventilation (NIV) and requires a significant amount of FiO2 (>40%)?

The baby's weight gain has been poor, necessitating an increase in the total fluid intake (TFI) up to 180ml/kg/day of Mom Own Milk (MOM) and fortifiers, as well as the use of diuretics.

In my experience, and based on most cases of CLD, these infants benefit from fluid restriction (<150ml/kg/day), which typically leads to a reduction in oxygen requirements. I usually supplement nutrition by adding preterm formula or high-energy formula to the TFI. However, I'm wondering if there are other ways to increase the nutritional value of (MOM+F) without using formula milk. adding Proteins?

Thanks,

Mo7

 

 

adding protein and Nacl supplementation might help

[Saravanan N]

I think rather than concentrating on Fluid intake - you can make up the calories required, as per new ESPGHAN guidelines(2022( you can increase calorie intake upto 140 - 160kcal/kg/day and protein upto 3.5-4g/kg/day by keeping track on weight gain. You can add adequate fortifiers by keeping TFI - 150-160ml/kg/day.

[Mo7]

On 5/9/2023 at 4:34 PM, Rao said:

adding protein and Nacl supplementation might help

We used to add protein to MOM or DHM but it is not a common practice in the UK, do you have any examples?

 

On 5/10/2023 at 6:38 AM, Saravanan N said:

I think rather than concentrating on Fluid intake - you can make up the calories required, as per new ESPGHAN guidelines(2022( you can increase calorie intake upto 140 - 160kcal/kg/day and protein upto 3.5-4g/kg/day by keeping track on weight gain. You can add adequate fortifiers by keeping TFI - 150-160ml/kg/day.

From my experience, any total fluid intake above 150ml/kg/day is associated with increased FiO2 requirement even with the use of diuretics. This is why, most CLD bundles concentrate fluid intake or limit intake to 120 - 150m.