# Nutrition Strategies for the Preterm Infant with Bronchopulmonary Dysplasia

## TL;DR

This paper reviews how nutrition can help prevent and manage bronchopulmonary dysplasia in preterm infants, emphasizing early high-protein and energy intake, and the benefits of human milk.

## Contribution

The paper provides a comprehensive review of nutritional strategies for BPD prevention and management, emphasizing early intervention and human milk feeding.

## Key findings

- Early high protein and energy intake reduce ventilator dependence and BPD risk.
- Human milk feeding is associated with lower BPD incidence compared to formula feeding.
- Micronutrient support and individualized fortification improve growth and outcomes in BPD.

## Abstract

Background/Objectives: Bronchopulmonary dysplasia (BPD) is a common chronic complication of prematurity, associated with significant morbidity. Nutrition is a key modifiable factor influencing lung growth, repair, and overall development. This review summarizes current evidence on nutritional strategies for BPD prevention and management. Methods: Narrative review was conducted with literature search in major databases using relevant keywords. Results: Early nutritional deficits are strongly associated with BPD. Higher early protein (3.5–4 g/kg/day) and energy intake (>60 kcal/kg/day in the first week, with progressive increases) reduce ventilator dependence. Lipids are essential to achieve caloric goals. Fluid restriction may reduce BPD risk but often results in undernutrition. Nutrient density, rather than fluid volume, is critical. Enteral nutrition, particularly mother’s own milk, consistently reduces BPD risk, whereas formula feeding is linked to higher BPD incidence. In established BPD, nutritional requirements are substantially increased. Feeding is frequently complicated by fluid restriction, gastroesophageal reflux, and poor oral coordination. Management strategies include higher energy intake (130–150 kcal/kg/day), adequate protein provision (3.5–4 g/kg/day), and careful use of lipid-based energy sources. Fortified human milk or enriched preterm formulas are essential, with individualized fortification improving growth. Micronutrient support is critical, and long-term follow-up is required, as post-discharge growth remains vulnerable and predicts later outcomes. Conclusions: Nutritional strategies to mitigate BPD should focus on early optimization of protein and energy intake, prioritization of nutrient density and promotion of human milk feeding. Targeted micronutrient support, individualized fortification and multidisciplinary care are essential to improve pulmonary and neurodevelopmental outcomes.