Роль липидов в питании недоношенных детей с бронхолёгочной дисплазией

Введение. Обзор посвящён значению липидов в питании недоношенных детей с бронхолёгочной дисплазией (БЛД). В последние годы увеличивается доля детей, родившихся преждевременно с очень низкой (ОНМТ) и экстремально низкой массой тела (ЭНМТ). Одним из часто встречающихся заболеваний детей с ОНМТ и особенно с ЭНМТ является БЛД. При тяжёлом течении БЛД установлена прямая зависимость между нутритивным статусом, функциональным состоянием лёгких и психомоторным развитием ребёнка. Потребности в нутриентах у недоношенных детей с БЛД повышены, и это предъявляет особые требования к их поступлению и проведению индивидуальной коррекции рациона с учётом всех особенностей развития ребёнка и наличия сопутствующей патологии. Оптимальным питанием для недоношенного ребёнка признано материнское молоко, в которое вносится обогатитель грудного молока. Однако жировой компонент в обогатителе практически отсутствует. Применение специализированных смесей также не обеспечивает калорийность рациона, которая требуется для поддержания скорости роста ребёнка с БЛД на фоне повышенных энергетических потребностей на 15–25% (по сравнению с пациентами, не развившими данное заболевание) и необходимого ограничения объёма вводимой жидкости в связи с большим риском гиперволемии малого круга кровообращения.

Заключение. Дополнительная дотация среднецепочечных триглицеридов представляется перспективным направлением, повышающим жировую составляющую рациона и его энергетическую ценность в условиях ограничения потребления жидкости у недоношенных детей с БЛД.

Участие авторов:
Басаргина М.А., Скворцова В.А., Харитонова Н.А. — концепция и дизайн исследования, написание текста, редактирование;
Басаргина М.А., Скворцова В.А., Илларионова М.С., Пинаева-Слыш Е.Л. — сбор и обработка материала;
Скворцова В.А., Харитонова Н.А. — статистическая обработка.
Все соавторы — утверждение окончательного варианта статьи, ответственность за целостность всех частей статьи.

Финансирование. Работа не имела финансовой поддержки.

Конфликт интересов. Авторы заявляют об отсутствии конфликта интересов.

Поступила 14.11.2023
Принята к печати 28.11.2023
Опубликована 27.12.2023

1. Glass H.C., Costarino A.T., Stayer S.A., Brett C.M., Cladis F., Davis P.J. Outcomes for extremely premature infants. Anesth. Analg. 2015; 120(6): 1337–51. https://doi.org/10.1213/ane.0000000000000705

2. Binepal N., Lemyre B., Dunn S., Daboval T., Aglipay M., Leduc S., et al. Systematic review and quality appraisal of international guidelines on perinatal care of extremely premature infants. Curr. Pediatr. Rev. 2015; 11(2): 126–34. https://doi.org/10.2174/1573396311666150608125529

3. Van de Pol C., Allegaert K. Growth patterns and body composition in former extremely low birth weight (ELBW) neonates until adulthood: a systematic review. Eur. J. Pediatr. 2020; 179(5): 757–71. https://doi.org/10.1007/s00431-019-03552-z

4. Johnson M.J. Early parenteral nutrition for preterm infants: perhaps more complicated than it first appears. Arch. Dis. Child. Fetal Neonatal Ed. 2022; 107(2): 116–7. https://doi.org/10.1136/archdischild-2021-323072

5. Fusch C., Bauer K., Böhles H.J., Jochum F., Koletzko B., Krawinkel M., et al. Neonatology/Paediatrics – Guidelines on Parenteral Nutrition, Chapter 13. Ger. Med. Sci. 2009; 7: Doc15. https://doi.org/10.3205/000074

6. Hay W.W. Jr. Strategies for feeding the preterm infant. Neonatology. 2008; 94(4): 245–54. https://doi.org/10.1159/000151643

7. Manea A., Boia M., Iacob D., Dima M., Iacob R.E. Benefits of early enteral nutrition in extremely low birth weight infants. Singapore Med. J. 2016; 57(11): 616–8. https://doi.org/10.11622/smedj.2016002

8. Salas A.A., Jerome M., Finck A., Razzaghy J., Chandler-Laney P., Carlo W.A. Body composition of extremely preterm infants fed protein-enriched, fortified milk: a randomized trial. Pediatr. Res. 2022; 91(5): 1231–7. https://doi.org/10.1038/s41390-021-01628-x

9. Thébaud B., Goss K.N., Laughon M., Whitsett J.A., Abman S.H., Steinhorn R.H., et al. Bronchopulmonary dysplasia. Nat. Rev. Dis. Primers. 2019; 5(1): 78. https://doi.org/10.1038/s41572-019-0127-7

10. Овсянников Д.Ю., Геппе Н.А., Малахов А.Б., Дегтярева Д.Н., ред. Бронхолегочная дисплазия. М.; 2020.

11. Dassios T., Williams E.E., Hickey A., Bunce C., Greenough A. Bronchopulmonary dysplasia and postnatal growth following extremely preterm birth. Arch. Dis. Child. Fetal Neonatal Ed. 2021; 106(4): 386–91. https://doi.org/10.1136/archdischild-2020-320816

12. Baud O., Laughon M., Lehert P. Survival without bronchopulmonary dysplasia of extremely preterm infants: a predictive model at birth. Neonatology. 2021; 118(4): 385–93. https://doi.org/10.1159/000515898

13. Скворцова В.А., Давыдова И.В., Фисенко А.П., Пинаева-Слыш Е.Л., Боровик Т.Э., Басаргина М.А. и др. Особенности нутритивного статуса недоношенных детей с бронхолегочной дисплазией в первом полугодии жизни. Педиатрия. Журнал им. Г.Н. Сперанского. 2021; 100(4): 161–70. https://doi.org/10.24110/0031-403X-2021-100-4-161-170 https://elibrary.ru/wdxjio

14. Kalikkot Thekkeveedu R., Guaman M.C., Shivanna B. Bronchopulmonary dysplasia: A review of pathogenesis and pathophysiology. Respir. Med. 2017; 132: 170–7. https://doi.org/10.1016/j.rmed.2017.10.014

15. Foglia E.E., Jensen E.A., Kirpalani H. Delivery room interventions to prevent bronchopulmonary dysplasia in extremely preterm infants. J. Perinatol. 2017; 37(11): 1171–9. https://doi.org/10.1038/jp.2017.74

16. Moschino L., Bonadies L., Baraldi E. Lung growth and pulmonary function after prematurity and bronchopulmonary dysplasia. Pediatr. Pulmonol. 2021; 56(11): 3499–508. https://doi.org/10.1002/ppul.25380

17. Savani R.C. Modulators of inflammation in bronchopulmonary dysplasia. Semin. Perinatol. 2018; 42(7): 459–70. https://doi.org/10.1053/j.semperi.2018.09.009

18. Yapicioglu Yildizdas H., Simsek H., Ece U., Ozlu F., Sertdemir Y., Narli N., et al. Effect of short-term morbidities, risk factors and rate of growth failure in very low birth weight preterms at discharge. J. Trop. Pediatr. 2020; 66(1): 95–102. https://doi.org/10.1093/tropej/fmz038

19. Uberos J., Jimenez-Montilla S., Molina-Oya M., García-Serrano J.L. Early energy restriction in premature infants and bronchopulmonary dysplasia: a cohort study. Br. J. Nutr. 2020; 123(9): 1024–31. https://doi.org/10.1017/S0007114520000240

20. Al-Jebawi Y., Agarwal N., Groh Wargo S., Shekhawat P., Mhanna M.J. Low caloric intake and high fluid intake during the first week of life are associated with the severity of bronchopulmonary dysplasia in extremely low birth weight infants. J. Neonatal Perinatal Med. 2020; 13(2): 207–14. https://doi.org/10.3233/NPM-190267

21. Huysman W.A., de Ridder M., de Bruin N.C., van Helmond G., Terpstra N., van Goudoever J.B., et al. Growth and body composition in preterm infants with bronchopulmonary dysplasia. Arch. Dis. Child. Fetal Neonatal Ed. 2003; 88(1): 46–51. https://doi.org/10.1136/fn.88.1.f46

22. Rocha G., Ribeiro O., Guimarães H. Fluid and electrolyte balance during the first week of life and risk of bronchopulmonary dysplasia in the preterm neonate. Clinics (Sao Paulo). 2010; 65(7): 663–74. https://doi.org/10.1590/s1807-59322010000700004

23. Malikiwi A.I., Lee Y.M., Davies-Tuck M., Wong F.Y Postnatal nutritional deficit is an independent predictor of bronchopulmonary dysplasia among extremely premature infants born at or less than 28 weeks gestation. Early Hum. Dev. 2019; 131: 29–35. https://doi.org/10.1016/j.earlhumdev.2019.02.005

24. Jensen E.A., Whyte R.K., Schmidt B., Bassler D., Vain N.E., Roberts R.S. Association between intermittent hypoxemia and severe bronchopulmonary dysplasia in preterm infants. Am. J. Respir. Crit. Care Med. 2021; 204(10): 1192–9. https://doi.org/10.1164/rccm.202105-1150OC

25. Hadchouel A., Franco-Montoya M.L., Delacourt C. Altered lung development in bronchopulmonary dysplasia. Birth Defects Res. A Clin. Mol. Teratol. 2014; 100(3): 158–67. https://doi.org/10.1002/bdra.23237

26. Baker C.D., Abman S.H. Impaired pulmonary vascular development in bronchopulmonary dysplasia. Neonatology. 2015; 107(4): 344–51. https://doi.org/10.1159/000381129

27. Sahni M., Bhandari V. Patho-mechanisms of the origins of bronchopulmonary dysplasia. Mol. Cell. Pediatr. 2021; 8(1): 21. https://doi.org/10.1186/s40348-021-00129-5

28. Simpson S.J., Hall G.L., Wilson A.C. Lung function following very preterm birth in the era of ‘new’ bronchopulmonary dysplasia. Respirology. 2015; 20(4): 535–40. https://doi.org/10.1111/resp.12503

29. Miller J., Tonkin E., Damarell R.A., McPhee A.J., Suganuma M., Suganuma H., et al. A systematic review and meta-analysis of human milk feeding and morbidity in very low birth weight infants. Nutrients. 2018; 10(6): 707. https://doi.org/10.3390/nu10060707

30. Moya F. Preterm nutrition and the lung. World Rev. Nutr. Diet. 2014; 110: 239–52. https://doi.org/10.1159/000358473

31. Martin C.R., Brown Y.F., Ehrenkranz R.A., O’Shea T.M., Allred E.N., Belfort M.B., et al. Nutritional practices and growth velocity in the first month of life in extremely premature infants. Pediatrics. 2009; 124(2): 649–57. https://doi.org/10.1542/peds.2008-3258

32. Perrin T., Pradat P., Larcade J., Masclef-Imbert M., Pastor-Diez B., Picaud J.C. Postnatal growth and body composition in extremely low birth weight infants fed with individually adjusted fortified human milk: a cohort study. Eur. J. Pediatr. 2023; 182(3): 1143–54. https://doi.org/10.1007/s00431-022-04775-3

33. Oczujda M., Miechowicz I., Szymankiewicz-Bręborowicz M., Czech-Szczapa B., Johnson M.J., Szczapa T. Impact of computer calculation program on quality of individualized parenteral nutrition and selected clinical parameters of extremely Low-Birth-Weight Infants. JPEN J. Parenter. Enteral Nutr. 2021; 45(6): 1197–203. https://doi.org/10.1002/jpen.2022

34. Lin Y.C., Chen Y.J., Huang C.C., Shieh C.C. Concentrated preterm formula as a liquid human milk fortifier at initiation stage in extremely low birth weight preterm infants: short term and 2-year follow-up outcomes. Nutrients. 2020; 12(8): 2229. https://doi.org/10.3390/nu12082229

35. Morty R.E. Recent advances in the pathogenesis of BPD. Semin. Perinatol. 2018; 42(7): 404–12. https://doi.org/10.1053/j.semperi.2018.09.001

36. Tinglan Y., Lei W., Jun J., Lijuan M., Jinzhu P., Zhengdong L., et al. Role medium-chain fatty acids in the lipid metabolism of infants. Front. Nutr. 2022; 9(9): 804880. https://doi.org/10.3389/fnut.2022.804880

37. Liu Z., Rochfort S., Cocks B. Milk lipidomics: what we know and what we don’t. Prog. Lipid Res. 2018; 71: 70–85. https://doi.org/10.1016/j.plipres.2018.06.002

38. Miliku K., Duan Q.L., Moraes T.J., Becker A.B., Mandhane P.J., Turvey S.E., et al. Human milk fatty acid composition is associated with dietary, genetic, sociodemographic, and environmental factors in the CHILD cohort study. Am. J. Clin. Nutr. 2019; 110(6): 1370–83. https://doi.org/10.1093/ajcn/nqz229.23,24

39. Grace J.A., Hennessy A.A., Ryan C. A., Ross R.P., Stanton C. Advances in infant formula. Annu. Rev. Food Sci. Technol. 2019; 10: 75–102. https://doi.org/10.1146/annurev-food-081318-104308

40. Lapillonne A. Enteral and parenteral lipid requirements of preterm infants. World Rev. Nutr. Diet. 2014; 110: 82–98. https://doi.org/10.1159/000358460

41. Westerbeek E.A., Slump R.A., Lafeber H.N., Knol J., Georgi G., Fetter WP., et al. The effect of enteral supplementation of specific neutral and acidic oligosaccharides on the faecal microbiota and intestinal microenvironment in preterm infants. Eur. J. Clin. Microbiol. Infect. Dis. 2013; 32(2): 269–76. https://doi.org/10.1007/s10096-012-1739-y

42. Mazzocchi A., D’Oria V., De Cosmi V., Bettocchi S., Milani G.P., Silano M., et al. The role of lipids in human milk and infant formulae. Nutrients. 2018; 10(5): 567. https://doi.org/10.3390/nu10050567.23

43. Pereira G.R., Baumgart S., Bennett M.J., Stallings V.A., Georgieff M.K., Hamosh M., et al. Use of high-fat formula for premature infants with bronchopulmonary dysplasia: metabolic, pulmonary, and nutritional studies. J. Pediatr. 1994; 124(4): 605–11. https://doi.org/10.1016/s0022-3476(05)83143-9

44. Hamosh M., Salem N. Jr. Long-chain polyunsaturated fatty acids. Biol. Neonate. 1998; 74(2): 106–20. https://doi.org/10.1159/000014017

45. Tanaka K., Tanaka S., Shah N., Ota E., Namba F. Docosahexaenoic acid and bronchopulmonary dysplasia in preterm infants: a systema­tic review and meta-analysis. J. Matern. Fetal Neonatal Med. 2022; 35(9): 1730–8. https://doi.org/10.1080/14767058.2020.1769590

46. Li H., Huang Z., Yang C., Han D., Wang X., Qiu X., et al. Association between plasma lysophosphatidic acid levels and bronchopulmonary dysplasia in extremely preterm infants: A prospective study. Pediatr. Pulmonol. 2023; 58(12): 3516–22. https://doi.org/10.1002/ppul.26685.23

47. Wei W., Jin Q., Wang X. Human milk fat substitutes: past achievements and current trends. Prog. Lipid Res. 2019; 74: 69–86. https://doi.org/10.1016/j.plipres.2019.02.001

48. Łoś-Rycharska E., Kieraszewicz Z., Czerwionka-Szaflarska M. Medium chain triglycerides (MCT) formulas in paediatric and allergological practice. Gastroenterol. Rev. 2016; 11(4): 226–31. https://doi.org/10.5114/pg.2016.61374.23,24

49. Jacquot A., Neveu D., Aujoulat F., Mercier G., Marchandin H., Jumas-Bilak E., et al. Dynamics and clinical evolution of bacterial gut microflora in extremely premature patients. J. Pediatr. 2011; 158(3): 390–6. https://doi.org/10.1016/j.jpeds.2010.09.007

50. Robinson D.T., Caplan M.S. Linking fat intake, the intestinal microbiome, and necrotizing enterocolitis in premature infants. Pediatr. Res. 2015; 77(1-2): 121–6. https://doi.org/10.1038/pr.2014.155

51. Hiltunen H., Löyttyniemi E., Isolauri E., Rautava S. Early nutrition and growth until the corrected age of 2 years in extremely preterm infants. Neonatology. 2018; 113(2): 100–7. https://doi.org/10.1159/000480633

52. Sahin S., Ozdemir T., Katipoglu N., Akcan A.B., Kaynak Turkmen M. Comparison of changes in breast milk macronutrient content during the first month in preterm and term infants. Breastfeed. Med. 2020; 15(1): 56–62. https://doi.org/10.1089/bfm.2019.0141

53. Romo J.A., Arsenault A.B., Laforce-Nesbitt S.S., Bliss J.M., Kumamoto C.A. Minimal effects of medium-chain triglyceride supplementation on the intestinal microbiome composition of premature infants: a single-center pilot study. Nutrients. 2022; 14(10): 2159. https://doi.org/10.3390/nu14102159

54. Khan Z., Morris N., Unterrainer H., Haiden N., Holasek S.J., Urlesberger B. Effect of standardized feeding protocol on nut­rient supply and postnatal growth of preterm infants: A prospective study. J. Neonatal Perinatal Med. 2018; 11(1): 11–9. https://doi.org/10.3233/NPM-18179

55. Miliku K., Duan Q.L., Moraes T.J., Becker A.B., Mandhane P.J., Turvey S.E., et al. Human milk fatty acid composition is associated with dietary, genetic, sociodemographic, and environmental factors in the CHILD cohort study. Am. J. Clin. Nutr. 2019; 110(6): 1370–83. https://doi.org/10.1093/ajcn/nqz229

56. Vizzari G., Morniroli D., Alessandretti F., Galli V., Colombo L., Turolo S., et al. Comparative analysis of docosahexaenoic acid (DHA) content in mother’s milk of term and preterm mothers. Nutrients. 2022; 14(21): 4595. https://doi.org/10.3390/nu14214595

57. Tozzi M.G., Moscuzza F., Michelucci A., Scaramuzzo R.T., Cosini C., Chesi F., et al. Nutrition, epigenetic markers and growth in preterm infants. J. Matern. Fetal Neonatal Med. 2021; 34(23): 3963–8. https://doi.org/10.1080/14767058.2019.1702952.27,34,35.

58. Sabel K.G., Lundqvist-Persson C., Bona E., Petzold M., Strandvik B. Fatty acid patterns early after premature birth, simultaneously analysed in mothers’ food, breast milk and serum phospholipids of mothers and infants. Lipids Health Dis. 2009; 8: 20. https://doi.org/10.1186/1476-511X-8-20

59. Hay W.W. Jr., Brown L.D., Denne S.C. Energy requirements, protein-energy metabolism and balance, and carbohydrates in preterm infants. World Rev. Nutr. Diet. 2014; 110: 64–81. https://doi.org/10.1159/000358459

60. Lingwood B.E., Al-Theyab N., Eiby Y.A., Colditz P.B., Donovan T.J. Body composition in very preterm infants before discharge is associated with macronutrient intake. Br. J. Nutr. 2020; 123(7): 800–6. https://doi.org/10.1017/S000711451900343X

61. Embleton N.D., Moltu S.J., Lapillonne A., van den Akker C.H.P., Carnielli V., Fusch C., et al. Enteral Nutrition in Preterm Infants (2022): A position paper from the ESPGHAN committee on nutrition and invited experts. J. Pediatr. Gastroenterol. Nutr. 2023; 76(2): 248–68. https://doi.org/10.1097/MPG.0000000000003642

62. Arsenault A.B., Gunsalus K.T.W., Laforce-Nesbitt S.S., Przystac L., DeAngelis E.J., Hurley M.E., et al. Dietary supplementation with medium-chain triglycerides reduces candida gastrointestinal colonization in preterm infants. Pediatr. Infect. Dis. J. 2019; 38(2): 164–8. https://doi.org/10.1097/INF.0000000000002042