Body composition in very preterm infants before discharge is associated with macronutrient intake

AbstractVery preterm infants experience poor postnatal growth relative to intra-uterine growth rates but have increased percentage body fat (%fat). The aim of the present study was to identify nutritional and other clinical predictors of infant %fat, fat mass (FM) (g) and lean mass (LM) (g) in very preterm infants during their hospital stay. Daily intakes of protein, carbohydrate, lipids and energy were recorded from birth to 34 weeks postmenstrual age (PMA) in fifty infants born <32 weeks. Clinical illness variables and anthropometric data were also collected. Body composition was assessed at 34–37 weeks PMA using the PEA POD Infant Body Composition System. Multiple regression analysis was used to identify independent predictors of body composition (%fat, FM or LM). Birth weight, birth weight z-score and PMA were strong positive predictors of infant LM. After adjustment for these factors, the strongest nutrient predictors of LM were protein:carbohydrate ratios (102–318 g LM/0·1 increase in ratio, P = 0·006–0·015). Postnatal age (PNA) and PMA were the strongest predictors of infant FM or %fat. When PNA and PMA were accounted for a higher intake of energy (–1·41 to –1·61 g FM/kJ per kg per d, P = 0·001–0·012), protein (–75·5 to –81·0 g FM/g per kg per d, P = 0·019–0·038) and carbohydrate (–27·2 to –30·0 g FM/g per kg per d, P = 0·012–0·019) were associated with a lower FM at 34–37 weeks PMA. Higher intakes of energy, protein and carbohydrate may reduce fat accumulation in very preterm infants until at least 34–37 weeks PMA.

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Variation in very preterm extrauterine growth in a European multicountry cohort

Archives of Disease in Childhood - Fetal and Neonatal Edition ◽

10.1136/archdischild-2020-319946 ◽

2020 ◽

pp. fetalneonatal-2020-319946

Author(s):

Rym El Rafei ◽

Pierre-Henri Jarreau ◽

Mikael Norman ◽

Rolf Felix Maier ◽

Henrique Barros ◽

...

Keyword(s):

Weight Gain ◽

Birth Weight ◽

Preterm Infants ◽

Postnatal Growth ◽

Population Based ◽

Very Preterm Infants ◽

Term Birth ◽

Very Preterm ◽

Country Level ◽

Relative Risks

ObjectiveExtrauterine growth restriction (EUGR) among very preterm infants is related to poor neurodevelopment, but lack of consensus on EUGR measurement constrains international research. Our aim was to compare EUGR prevalence in a European very preterm cohort using commonly used measures.DesignPopulation-based observational study.Setting19 regions in 11 European countries.Patients6792 very preterm infants born before 32 weeks’ gestational age (GA) surviving to discharge.Main outcome measuresWe investigated two measures based on discharge-weight percentiles with (1) Fenton and (2) Intergrowth (IG) charts and two based on growth velocity (1) birth weight and discharge-weight Z-score differences using Fenton charts and (2) weight-gain velocity using Patel’s model. We estimated country-level relative risks of EUGR adjusting for maternal and neonatal characteristics and associations with population differences in healthy newborn size, measured by mean national birth weight at 40 weeks’ GA.ResultsAbout twofold differences in EUGR prevalence were observed between countries for all indicators and these persisted after case-mix adjustment. Discharge weight <10th percentile using Fenton charts varied from 24% (Sweden) to 60% (Portugal) and using IG from 13% (Sweden) to 43% (Portugal), while low weight-gain velocity ranged from 35% (Germany) to 62% (UK). Mean term birth weight strongly correlated with both percentile-based measures (Spearman’s rho=−0.90 Fenton, −0.84 IG, p<0.01), but not Patel’s weight-gain velocity (rho: −0.38, p=0.25).ConclusionsVery preterm infants have a high prevalence of EUGR, with wide variations between countries in Europe. Variability associated with mean term birth weight when using common postnatal growth charts complicates international benchmarking.

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Antenatal and Postnatal Growth and 5-Year Cognitive Outcome in Very Preterm Infants

PEDIATRICS ◽

10.1542/peds.2013-1187d ◽

2013 ◽

Vol 133 (1) ◽

pp. X8-X8

Keyword(s):

Preterm Infants ◽

Postnatal Growth ◽

Cognitive Outcome ◽

Very Preterm Infants ◽

Very Preterm

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Customized Human Milk Fortification Based on Measured Human Milk Composition to Improve the Quality of Growth in Very Preterm Infants: A Mixed-Cohort Study Protocol

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18020823 ◽

2021 ◽

Vol 18 (2) ◽

pp. 823

Author(s):

Manuela Cardoso ◽

Daniel Virella ◽

Israel Macedo ◽

Diana Silva ◽

Luís Pereira-da-Silva

Keyword(s):

Human Milk ◽

Preterm Infants ◽

Fat Mass ◽

Study Protocol ◽

Milk Composition ◽

Fixed Dose ◽

Very Preterm Infants ◽

Very Preterm ◽

Pea Pod

Adequate nutrition of very preterm infants comprises fortification of human milk (HM), which helps to improve their nutrition and health. Standard HM fortification involves a fixed dose of a multi-nutrient HM fortifier, regardless of the composition of HM. This fortification method requires regular measurements of HM composition and has been suggested to be a more accurate fortification method. This observational study protocol is designed to assess whether the target HM fortification method (contemporary cohort) improves the energy and macronutrient intakes and the quality of growth of very preterm infants, compared with the previously used standard HM fortification (historical cohorts). In the contemporary cohort, a HM multi-nutrient fortifier and modular supplements of protein and fat are used for HM fortification, and the enteral nutrition recommendations of the European Society for Paediatric Gastroenterology Hepatology and Nutrition for preterm infants will be considered. For both cohorts, the composition of HM is assessed using the Miris Human Milk analyzer (Uppsala, Sweden). The quality of growth will be assessed by in-hospital weight, length, and head circumference growth velocities and a single measurement of adiposity (fat mass percentage and fat mass index) performed just after discharge, using the air displacement plethysmography method (Pea Pod, Cosmed, Italy). ClinicalTrials.gov registration number: NCT04400396.

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Aortic growth arrest after preterm birth: a lasting structural change of the vascular tree

Journal of Developmental Origins of Health and Disease ◽

10.1017/s2040174411000274 ◽

2011 ◽

Vol 2 (4) ◽

pp. 218-225 ◽

Cited By ~ 18

Author(s):

U. Schubert ◽

M. Müller ◽

A.-K. Edstedt Bonamy ◽

H. Abdul-Khaliq ◽

M. Norman

Keyword(s):

Preterm Birth ◽

Carotid Artery ◽

Preterm Infants ◽

Growth Failure ◽

Later Life ◽

Postnatal Growth ◽

Direct Result ◽

Arterial Tree ◽

Very Preterm Infants ◽

Very Preterm

Young people who are born very preterm exhibit a narrower arterial tree as compared with people born at term. We hypothesized that such arterial narrowing occurs as a direct result of premature birth. The aim of this study was to compare aortic and carotid artery growth in infants born preterm and at term. Observational and longitudinal cohort study of 50 infants (21 born very preterm, all appropriate for gestational age, 29 controls born at term) was conducted. Diameters of the upper abdominal aorta and common carotid artery were measured with ultrasonography at three months before term, at term and three months after term-equivalent age. At the first assessment, the aortic end-diastolic diameter (aEDD) was slightly larger in very preterm infants as compared with fetal dimensions. Fetal aortic EDD increased by 2.6 mm during the third trimester, whereas very preterm infants exhibited 0.9 mm increase in aEDD during the same developmental period (P < 0.001 for group difference). During the following 3-month period, aortic growth continued unchanged (+0.9 mm) in very preterm infants, whereas postnatal growth in term controls slowed down to +1.3 mm (P < 0.001 v. fetal aortic growth). At the final examination, aEDD was 22% and carotid artery EDD was 14% narrower in infants born preterm compared with controls, also after adjusting for current weight (P < 0.01). Aortic and carotid artery growth is impaired after very preterm birth, resulting in arterial narrowing. Arterial growth failure may be a generalized vascular phenomenon after preterm birth, with implications for cardiovascular morbidity in later life.

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How does higher compare with lower amino acid intake in parenteral nutrition for very low birth weight or very preterm infants?

Cochrane Clinical Answers ◽

10.1002/cca.2181 ◽

2018 ◽

Author(s):

Nai Ming Lai

Keyword(s):

Birth Weight ◽

Amino Acid ◽

Low Birth Weight ◽

Parenteral Nutrition ◽

Preterm Infants ◽

Very Low Birth Weight ◽

Very Preterm Infants ◽

Very Preterm ◽

Acid Intake ◽

Amino Acid Intake

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Regionalized Perinatal Care Systems and Very Low-Birth-Weight and Very Preterm Infants—Reply

JAMA ◽

10.1001/jama.2010.1857 ◽

2010 ◽

Vol 304 (24) ◽

pp. 2696

Author(s):

Sarah M. Lasswell

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Preterm Infants ◽

Very Low Birth Weight ◽

Perinatal Care ◽

Very Preterm Infants ◽

Very Preterm ◽

Care Systems

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Serial Assessment of Body Fat and Fat-Free Mass Accretion in Very Preterm Infants: A Randomized Trial

Current Developments in Nutrition ◽

10.1093/cdn/nzaa054_139 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 1067-1067

Author(s):

Ariel Salas ◽

Maggie Jerome ◽

Paula Chandler-Laney ◽

Namasivayam Ambalavanan

Keyword(s):

Body Composition ◽

Preterm Infants ◽

Body Fat ◽

Intervention Group ◽

Feeding Practices ◽

Control Group ◽

Very Preterm Infants ◽

Very Preterm ◽

Study Participants ◽

Serial Assessments

Abstract Objectives To incorporate assessment of body composition in the routine care of preterm infants to guide feeding practices before and after hospital discharge. Methods Very preterm infants with gestational ages between 29 and 32 weeks of gestation were included. Infants with gastrointestinal or neurologic malformations and terminal illness needing to limit or withhold support were excluded. All study participants were eligible for serial assessments of body composition between birth and 32 weeks PMA, at 36 weeks PMA or hospital discharge, and at 3 months of corrected age. Infants randomly assigned to the intervention group had the information about infant body composition available to the clinicians caring for them (including reference data). Infants randomly assigned to the control group also underwent serial assessments, but this information on infant body composition was not shown to the clinicians caring for them. The primary outcome was % body fat (%BF) estimated by air displacement plethysmography. Results Fifty very preterm infants were randomized. Mean birthweight of study participants was 1387 g +/– SD 283 and median gestational age at birth was 30 weeks (IQR: 30 – 31). Sociodemographic characteristics did not differ between groups. Mean %BF between birth and 32 weeks PMA (n = 45) was 6 +/– 4, mean %BF at 36 weeks PMA (n = 35) was 14 +/– 4, and mean %BF at 3 months of corrected age (n = 25) was 20 +/– 4. Mean differences in %BF between the intervention group and the control group were not statistically significant at 36 weeks PMA (−0.8) or 3 months corrected age (−1.2). Similarly, feeding practices during hospitalization did not differ between groups. Growth outcomes did not differ between groups. Conclusions Serial assessments of body composition at birth, 36 weeks PMA, and 3 months corrected age in very preterm infants show increased %BF in both intervention and control groups without an apparent influence of the intervention on feeding practices. While 36 weeks PMA has been a common assessment point for research purposes, body composition assessments may need to be done at earlier intervals in order to make meaningful clinical changes to the infant diet in order to affect body composition later in infancy. Funding Sources UAB OHDRC.

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