49 Bronchopulmonary dysplasia, IGF-I & nutrition 3 Introduction With reported incidences up to 30%, bronchopulmonary dysplasia (BPD) is one of the most frequent complications following preterm birth. 1-3 Lately, more insight has been gained in the pathogenesis of BPD.4 However, therapeutic options to prevent BPD and current drug therapies only show a moderate reduction of the incidence of BPD. 1 2 Previous research has shown that Insulin-like Growth Factor I (IGF-I) plays a role in the development and differentiation of several different lung cells 5 and has antiinflammatory and anti-oxidative effects. 6-8 Therefore, IGF-I could play an important role in the development of BPD. Indeed, a recent trial targeting the prevention of retinopathy of prematurity (ROP) by IGF-1 infusion showed a concomitant decline in BPD occurrence. 9 Various factors, however, e.g. nutritional intake, genetic predisposition, and comorbidities have been associated with IGF-I levels 10 and could therefore be of importance in the association between IGF-I and the occurrence of BPD. Price and colleagues demonstrated that protein intake was associated with Insulinlike Growth Factor Binding Protein 3 (IGFBP-3).11 Nutrition might be of particular interest to further investigate, because, in contrast to more invasive interventions such as IGF-I administration, it is generally feasible to implement nutritional interventions. This study aims to explore whether IGF-I levels and the rate of increase in IGF-I are associated with the occurrence of BPD. Moreover it is explored whether these potential associations are impacted by the type nutrition. Methods Study population The study population consisted of preterm infants who were admitted to the neonatal intensive care unit of Amsterdam UMC, location VU University medical center. The infants were born between 2015 and 2018, with a gestational age of 24 to 32 weeks and participated in the NUTRIE study, a longitudinal observational study on nutrition in relation to the endocrine regulation of preterm growth.12 Power calculations were done for the primary outcome of the NUTRIE study. No power calculations were done for the results presented in this paper. Informed consent was obtained in the first week of life and participants were followedupfrombirthtotwoyearscorrectedage. Infantswithsubstantial congenital anomalies based on a chromosomal disorder or syndrome were excluded. Infants could be enrolled in other studies during inclusion. These studies did not have overlapping outcomes. The study was approved by the medical research ethics
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