Preventing Bronchopulmonary Dysplasia Through Nutrition in Preterm Infants: A Systematic Review of the Literature

Context Bronchopulmonary dysplasia (BPD) is a multifactorial, chronic lung disease affecting preterm infants. Several interventions have been proposed to prevent BPD; a role for specific nutritional practices has also been suggested. Objective To evaluate, by means of a systematic review of the available literature, which nutritional interventions might prevent BPD in preterm infants. Data Sources PubMed, The Cochrane Library, and CINAHL were searched using a predefined PICO/PECO strategy for studies recruiting preterm infants (gestational age <37 weeks), examining nutritional interventions, and reporting on BPD. No study design limitation was applied. Articles were included if written in English and published before March 3, 2024. Data Extraction The literature search yielded 1825 results. After screening, removal of duplicates, and retrieval of additional papers by hand-searching, 135 papers were included in the systematic review and categorized according to their main topic (parenteral nutrition, enteral nutrition, and nutritional supplements). Study quality assessment was performed using the criteria set out by the Cochrane Handbook for Systematic Reviews of Interventions. Data Analysis Several nutritional interventions appear to reduce the risk of BPD in preterm infants. These include early optimization and balance of fluid, energy, and nutrient intakes through parenteral nutrition, early enteral feeding, and use of own mother's milk in a dose-dependent fashion. The quality of the examined literature was mixed. Conclusion The available literature suggests that several nutritional interventions could play a role, together with intensive and respiratory care, to minimize the risk of chronic lung disease in preterm infants. However, the evidence for some interventions is inconclusive and deserves additional, well-designed research.Systematic Review Registration PROSPERO registration no. CRD42022300524.