{
  "abstract": "Rationale: Untargeted metabolomics may identify novel pathways involved in bronchopulmonary dysplasia (BPD), a poorly understood lung disease in extremely premature infants. Objective: To identify metabolites and pathways altered in infants who develop BPD through a metabolome-wide association study. Methods: We performed untargeted urinary metabolomics in 314 infants (<29 weeks gestational age) at two time points between postnatal days 5-15 and 23-32, with detailed time-series for 28 infants. We compared metabolite levels between infants with and without BPD at 36 weeks postmenstrual age using logistic regression and pathway enrichment analysis. A stratified analysis by nutrition type was performed at 23-32 days. Results: Among the 913 analyzed urinary metabolites, 23 and 68 were nominally associated with BPD between postnatal days 5-15 and 23-32, respectively (p<0.05). We found enrichment in the lactoyl amino acid sub-pathway (5-15 days; p=0.005, q=0.4) and xanthine metabolism and fatty acid metabolism (23-32 days; p[≤]0.002, q<0.1). Most BPD-differential metabolites were lower in infants with BPD at days 23-32 (OR=7.1, p=2x10-6), with similar patterns among infants receiving parenteral (OR=9.2, p=7x10-7) and full enteral nutrition (OR=6.1, p=0.003). Twenty-four metabolites, including vitamins C, B1, and B6, were lower in infants on parenteral nutrition with BPD at postnatal days 23-32. Discussion: BPD in extremely premature infants was associated with lower levels of vitamin-related metabolites and dysregulation of lactoyl amino acids, xanthine, and fatty acid metabolism. BPD-differential metabolites were lower in infants with BPD during the fourth week of life, potentially related to higher energy demand, metabolic dysregulation, insufficient nutrient availability, and/or impaired intestinal absorption.",
  "abstract_shown": true,
  "affiliations": [
    "University of California San Francisco"
  ],
  "article_type": "PUBLISHAHEADOFPRINT",
  "arxiv": null,
  "author_total": 6,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "T. I. Malave-Mendez"
    },
    {
      "name": "M. A. Guardado"
    },
    {
      "name": "C. Chapin"
    },
    {
      "name": "R. D. Hernandez"
    },
    {
      "name": "P. Ballard"
    },
    {
      "name": "D. G. Torgerson"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/fm86rz3xekkdr.bib",
  "cited_by": 0,
  "doi": "10.64898/2026.11.06.26367452",
  "fulltext_url": "https://www.medrxiv.org/content/10.64898/2026.11.06.26367452v1.full",
  "id": "fm86rz3xekkdr",
  "issns": [],
  "landing_url": "https://www.medrxiv.org/content/10.64898/2026.11.06.26367452v1",
  "language": null,
  "licence": "CC-BY-NC-ND",
  "licence_label": "CC BY-NC-ND",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "medrxiv",
      "pediatrics"
    ]
  ],
  "openalex": null,
  "pdf_url": "https://www.medrxiv.org/content/10.64898/2026.11.06.26367452v1.full.pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-11-06",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/fm86rz3xekkdr.ris",
  "sources": [
    {
      "first_seen": "2026-11-10T00:22:06Z",
      "native_id": "10.64898/2026.11.06.26367452",
      "source": "medrxiv",
      "url": "https://www.medrxiv.org/content/10.64898/2026.11.06.26367452v1"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "medrxiv:pediatrics",
      "subfield": "reproductive-child"
    }
  ],
  "title": "Metabolome-wide Association Study of Bronchopulmonary Dysplasia in Extremely Premature Infants",
  "title_text": "Metabolome-wide Association Study of Bronchopulmonary Dysplasia in Extremely Premature Infants",
  "type": "preprint",
  "updated_at": "2026-11-10T00:22:06Z",
  "url": "https://research.draconitic.com/paper/fm86rz3xekkdr",
  "venue": "medRxiv",
  "versions": []
}