Clinical and Ultrasound Assessment of Body Composition in Preterm Infants at Discharge: an Observational Study

Overview

Journal BMJ Paediatr Open

Publisher BMJ Publishing Group

Specialty Pediatrics

Date 2025 Jan 8

PMID 39773975

Authors

Montserrat Izquierdo Renau

Elsa Garcia Gonzalez

Carla Balcells-Esponera

Beatriz Del Rey Hurtado de Mendoza

Emilio J Inarejos Clemente

Isabel Iglesias-Platas

Affiliations

Soon will be listed here.

Abstract

Objectives: While the target of growth of very preterm infants (VPIs) during Neonatal Intensive care unit (NICU) admission is still controversial, the most accepted objective is that they should follow their intrauterine trajectory in terms of growth and body composition (BC). BC is difficult to measure in clinical daily routine but proxies like body ratios and skinfolds have been used. Prenatal and postnatal factors can influence the growth and BC of VPIs in the NICU.

Design, Setting And Patients: We conducted a case-control study, including preterm infants born before 32 weeks gestational age at term-corrected age (TCA) and healthy late preterm or term infants as controls and also a retrospective cohort analysis of factors influencing VPI's BC at discharge. Patients had an anthropometric evaluation at discharge including weight, length, head circumference, body circumferences (waist, arm), skinfolds and abdominal ultrasound (US).

Results: 191 VPIs were eligible for discharge visits, but only 83 had a complete evaluation and we collected 26 controls. VPIs at TCA were smaller in weight, length and head circumference but had greater ratios (arm fat-to-circumference and waist-to-length). Abdominal fat assessed by US was smaller in VPIs compared with term infants. Intrauterine growth restriction-VPI remained smaller at TCA but experienced less weight z-score loss. Sex did not seem to influence growth and BC proxies at TCA. Higher nutritional support during the first 2 weeks of life was related to a lower loss of length z-scores, and exclusive human milk feeding correlates with arm fat-to-circumference ratio.

Conclusions: Growth and BC of VPIs can be approached using simpler measures in clinical practice. Arm skinfolds and arm circumferences point to a greater adiposity of VPIs at TCA compared with term infants, while US does not show a greater visceral adiposity. Nutritional factors played a small effect in BC at the time of discharge.

References

Daly-Wolfe K, Jordan K, Slater H, Beachy J, Moyer-Mileur L . Mid-arm circumference is a reliable method to estimate adiposity in preterm and term infants. Pediatr Res. 2015; 78(3):336-41. DOI: 10.1038/pr.2015.103. View

Roggero P, Gianni M, Forzenigo L, Tondolo T, Taroni F, Liotto N . No relative increase in intra-abdominal adipose tissue in healthy unstressed preterm infants at term. Neonatology. 2014; 107(1):14-9. DOI: 10.1159/000364855. View

Horbar J, Ehrenkranz R, Badger G, Edwards E, Morrow K, Soll R . Weight Growth Velocity and Postnatal Growth Failure in Infants 501 to 1500 Grams: 2000-2013. Pediatrics. 2015; 136(1):e84-92. DOI: 10.1542/peds.2015-0129. View

Cerasani J, Ceroni F, De Cosmi V, Mazzocchi A, Morniroli D, Roggero P . Human Milk Feeding and Preterm Infants' Growth and Body Composition: A Literature Review. Nutrients. 2020; 12(4). PMC: 7230190. DOI: 10.3390/nu12041155. View

Stokes T, Holston A, Olsen C, Choi Y, Curtis J, Higginson J . Preterm infants of lower gestational age at birth have greater waist circumference-length ratio and ponderal index at term age than preterm infants of higher gestational ages. J Pediatr. 2012; 161(4):735-41.e1. DOI: 10.1016/j.jpeds.2012.03.023. View

Holston A, Stokes T, Olsen C, Choi Y, Curtis J, Higginson J . Novel noninvasive anthropometric measure in preterm and full-term infants: normative values for waist circumference:length ratio at birth. Pediatr Res. 2013; 74(3):299-306. DOI: 10.1038/pr.2013.109. View

Yumani D, de Jongh D, Lafeber H, van Weissenbruch M . A comparative study using dual-energy X-ray absorptiometry, air displacement plethysmography, and skinfolds to assess fat mass in preterms at term equivalent age. Eur J Pediatr. 2020; 180(3):919-927. PMC: 7886735. DOI: 10.1007/s00431-020-03812-3. View

Manapurath R, Gadapani B, Pereira-da-Silva L . Body Composition of Infants Born with Intrauterine Growth Restriction: A Systematic Review and Meta-Analysis. Nutrients. 2022; 14(5). PMC: 8912478. DOI: 10.3390/nu14051085. View

Greenbury S, Angelini E, Ougham K, Battersby C, Gale C, Uthaya S . Post-natal growth of very preterm neonates - Authors' reply. Lancet Child Adolesc Health. 2022; 6(3):e11. DOI: 10.1016/S2352-4642(22)00025-6. View

10.

Larciprete G, Valensise H, Di Pierro G, Vasapollo B, Casalino B, Arduini D . Intrauterine growth restriction and fetal body composition. Ultrasound Obstet Gynecol. 2005; 26(3):258-62. DOI: 10.1002/uog.1980. View

11.

Osborn D, Schindler T, Jones L, Sinn J, Bolisetty S . Higher versus lower amino acid intake in parenteral nutrition for newborn infants. Cochrane Database Syst Rev. 2018; 3:CD005949. PMC: 6494253. DOI: 10.1002/14651858.CD005949.pub2. View

12.

Martinez Perez J, Perez Martin P . [Intraclass correlation coefficient]. Semergen. 2022; 49(3):101907. DOI: 10.1016/j.semerg.2022.101907. View

13.

Tremblay G, Boudreau C, Belanger S, St-Onge O, Pronovost E, Simonyan D . Body Composition in Very Preterm Infants: Role of Neonatal Characteristics and Nutrition in Achieving Growth Similar to Term Infants. Neonatology. 2016; 111(3):214-221. DOI: 10.1159/000450882. View

14.

Gottschall C, Tarnowski M, Machado P, Raupp D, Marcadenti A, Rabito E . Predictive and concurrent validity of the Malnutrition Universal Screening Tool using mid-upper arm circumference instead of body mass index. J Hum Nutr Diet. 2019; 32(6):775-780. DOI: 10.1111/jhn.12665. View

15.

Figueras F, Gratacos E . An integrated approach to fetal growth restriction. Best Pract Res Clin Obstet Gynaecol. 2016; 38:48-58. DOI: 10.1016/j.bpobgyn.2016.10.006. View

16.

Calek E, Binder J, Palmrich P, Eibensteiner F, Thajer A, Kainz T . Effects of Intrauterine Growth Restriction (IUGR) on Growth and Body Composition Compared to Constitutionally Small Infants. Nutrients. 2023; 15(19). PMC: 10574227. DOI: 10.3390/nu15194158. View

17.

Al-Theyab N, Donovan T, Eiby Y, Colditz P, Lingwood B . Fat trajectory after birth in very preterm infants mimics healthy term infants. Pediatr Obes. 2018; 14(3):e12472. DOI: 10.1111/ijpo.12472. View

18.

Casirati A, Somaschini A, Perrone M, Vandoni G, Sebastiani F, Montagna E . Preterm birth and metabolic implications on later life: A narrative review focused on body composition. Front Nutr. 2022; 9:978271. PMC: 9521164. DOI: 10.3389/fnut.2022.978271. View

19.

Kiger J, Taylor S, Wagner C, Finch C, Katikaneni L . Preterm infant body composition cannot be accurately determined by weight and length. J Neonatal Perinatal Med. 2016; 9(3):285-90. DOI: 10.3233/NPM-16915125. View

20.

Cauble J, Dewi M, Hull H . Validity of anthropometric equations to estimate infant fat mass at birth and in early infancy. BMC Pediatr. 2017; 17(1):88. PMC: 5368988. DOI: 10.1186/s12887-017-0844-6. View