48 Chapter 3 Abstract Objective Insulin-like growth factor I (IGF-I) has been suggested as an important factor in the pathogenesis of bronchopulmonary dysplasia (BPD). In turn, nutrition has been associated with IGF-I levels and could be of importance in the pathogenesis of BPD. This study aimed to explore the association between nutrition, the IGF-I axis and the occurrence BPD. Design An observational study was conducted from 2015 to 2018 in a level III NICU. Eightysix infants were included (44 male, mean gestational age 29.0 weeks (standard deviation 1.7 weeks) Serum IGF-I (µgram/L) and Insulin-like growth factor binding protein 3 (IGFBP-3; mg/L) was measured at birth and at 2, 4 and 6 weeks postnatal age and BPD was diagnosed at 36 weeks postmenstrual age. (https://www. trialregister.nl/trial/5171) Results Twenty-nine out of 86 infants were diagnosed with BPD. The odds ratio (OR) for the occurrence of BPD was 0.68, 95% CI 0.48 – 0.96 for every µgram/L per week increase in IGF-I, corrected for gestational age. The change in IGF-I in µgram/L/ week, gestational age in weeks and a week of predominant donor human milk were associated with the occurrence of BPD in multivariable analysis (respectively OR 0.63 (0.43 – 0.92), OR 0.44 (0.26 – 0.76) and 7.6 (1.2 – 50.4)). IGFBP-3 was not associated with the occurrence of BPD in multivariable analysis. Conclusion A slow increase in IGF-I levels and a lower gestational age increase the odds of BPD. Donor human milk might also increase the odds of BPD and should be further explored.
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