Studying the Effect of Nutritional Status on Lung Development in Premature Neonates Using UTE MRI

Ekaterina Dianova, Cincinnati Children's Hospital Medical Center, Union, KY, United States; Paul Kingma, Cincinnati Children's Hospital Medical Center, OH, United States; Kera McNelis, Cincinnati Children's Hospital Medical Center, United States; Jason Woods, Cincinnati Children's Hospital Medical Center, United States; Nara Higano, Cincinnati Children's Hospital Medical Center, United States

Background: Restricted fetal and neonatal growth is a known risk factor for bronchopulmonary dysplasia (BPD), the leading cause of mortality and morbidity in preterm neonates. There is a poor understanding of how nutritional intake, weight gain, and linear growth are directly related to lung growth and lung development in preterm infants with BPD.

Objectives: This study aims to identify the effect of neonatal nutritional status on lung growth and development by comparing caloric and protein intake, weight gain, and linear growth to lung volumes, lung mass, lung density, and BPD phenotypes using UTE MRI.

Design/Methods: This is a retrospective study. Infants born before 32 weeks of GA with weight < 1500 gram and diagnosed with BPD of any severity who underwent UTE MRI as a part of another study or for any clinical indications were included. Caloric, protein, and fluid daily intake for the first four weeks of life and weekly growth parameters along with respiratory parameters including lung volume, mass, lung density, and BPD phenotype obtained with UTE MRI were analyzed.

Results: The cohort included ninety-five neonates with mean GA (SD) 26.1 (1.8) weeks, BW (SD) 790 (250) g, 43% males. Nineteen (20%) infants had mild, 32 (34%) – moderate, and 44 (46%) – severe BPD. Infants with severe and moderate BPD were born at significantly earlier GA, had smaller BW and z-scores for weight, length, HC at birth (p < 0.05), were shorter for PMA at 4 weeks of life, 36 weeks, and term PMA (p < 0.05) and had less caloric and protein intake for the first 4 weeks of life than infants with mild BPD (p < 0.05). UTE MRI showed that lung mass and lung volume per BSA were consistently increasing from mild to moderate and to severe BPD (237, 311, 384 g/m2 and 443, 534, 738 ml/m2 respectively, p< 0.05). There was a significant negative correlation of total lung mass per BSA with caloric intake during the first four weeks of life (r=-0.23, p< 0.05). The proportion of lung tissue with normal density significantly declined as the severity of BPD progressed.

Conclusion: Lower caloric and protein intake during the first four weeks of life is significantly associated with more severe BPD, poor linear growth from birth to term PMA, increased lung mass, and lung volume per BSA and can be evident using UTE MRI.