340 meager stores, 5 (3) medical treatment of infants with BPD (fluid restriction, cata- bolic steroids, 6 and diuretics, 7 ) jeopar- dizes nutritional status and growth, (4) there is an elevated metabolic rate caused by the “work of breathing,” 8 and (5) inadequate intake or malabsorption of nutrients. 9 Although catch-up growth has not been achieved within 3 years of age (adjusted for prematurity), 2,3 no controlled nutritional intervention study has been conducted in an attempt to in- duce catch-up growth after discharge. Because elevated metabolic rate was identified at post-term age in infants with BPD who had delayed growth, 10 it has been recommended that supplemental energy be added to standard term infant formulas. 11 Data on nutrient accretion in healthy premature infants during early neonatal life who were fed varying pro- tein/energy ratios support the need for a high protein to energy ratio to deposit lean, as opposed to fat, mass. 12 H owever, whether the same protein/energy ratio is beneficial beyond term age in infants with growth failure is uncertain. If meta- bolic rates are indeed elevated for a pro- longed period, then energy alone may compensate and support growth after hospital discharge without adding fur- G G rowth and body composition in infants with bronchopulmonary dysplasia up to 3 months corrected age: A randomized trial of a high-energy nutrient-enriched formula fed after hospital discharge Janet A. Brunton, PhD, Saroj Saigal, MD, and Stephanie A. Atkinson, PhD Growth failure and delayed skeletal min- eralization occur in preterm infants who survive with bronchopulmonary dyspla- sia. 1-4 There are multiple contributing factors: (1) affected infants are compro- mised at birth with limited body stores because of a shortened gestation, (2) in- adequate provision of nutrients during the acute phase of lung disease depletes From the Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada. Funded by a grant from the Ontario Ministry of Health, with formula manufactured to investigators’ specifications and donated by Wyeth-Ayerst Int., Radnor, Pennsylvania. Submitted for publication March 26, 1997; revisions received Sept. 5, 1997, J an. 9, 1998; accepted Feb. 9, 1998. Reprint requests: Stephanie Atkinson, PhD, Profes- sor, Department of Pediatrics, HSC 3V42, McMas- ter University, 1200 Main St. West, Hamilton, On- tario, Canada L8N 3Z5. Copyright © 1998 by Mosby, Inc. 0022-3476/98/$5.00 + 0 9/21/89554 BMC Bone mineral content BPD Bronchopulmonar y dysplasia CA Corrected age (age adjusted for prematurity based on last menstrual period) DXA D ual energy x-ray absorptiometry EF Enriched formula PMA Postmenstrual age SF Standard formula SPA Single photon absorptiometry Objectives: (1) To determine whether nutrient malabsorption or inadequate nutrient intake were involved in the cause of growth delay in patients with bronchopulmonary dysplasia, and (2) to determine whether a nutrient-enriched formula given to infants with bronchopulmonary dysplasia to 3 months correct- ed age improves the rate of growth with greater lean and bone mass accretion when compared with infants fed an isoenergetic standard infant formula. Study design: A blinded, nutrition intervention trial of 60 preterm infants with bronchopulmonary dysplasia (birth weight, 866 ± 169 g, gestational age, 26 ± 1.5 weeks) randomized to either nutrient-enriched formula or standard formula. Growth, body composition, and nutrient retention were compared between groups by Student’s t tests and analysis of covariance. Results: Infants fed the enriched formula had significantly greater nitrogen and mineral retention at 38 weeks’ postmenstrual age, and only the infants fed enriched formula had zinc retention similar to the intrauterine accretion. At 3 months cor- rected age infants fed enriched formula attained greater length (P < .05), greater radial bone mineral content ( P < .01), and greater lean mass ( P < .01). The male in- fants in the enriched formula group had greater whole body bone mineral content than did male infants in the standard formula group ( P = .02). Conclusions: Greater linear growth and lean and bone mass in the enriched formula group suggests that infants with bronchopulmonary dysplasia attain faster “catch-up” growth when fed higher intakes of protein, calcium, phospho- rus, and zinc than provided in standard proprietary formulas. (J Pediatr 1998;133:340-5) See editorial, p. 315.