1
|
Lücke L, Fusch C, Knab K, Schäfer S, Zimmermann JL, Felderhoff-Müser U, Meis A, Lohmüller-Weiß S, Szakacs-Fusch A, Rochow N. Reproducibility of Air Displacement Plethysmography in Term and Preterm Infants-A Study to Enhance Body Composition Analysis in Clinical Routine. Nutrients 2024; 16:1810. [PMID: 38931164 PMCID: PMC11206819 DOI: 10.3390/nu16121810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 06/02/2024] [Accepted: 06/04/2024] [Indexed: 06/28/2024] Open
Abstract
The quality-initiative analysis of weekly duplicate PEAPOD® body composition measurements was conducted from clinical practice (January to September 2021) on preterm and term infants without respiratory support. Statistical analysis, including regression analysis, Bland-Altman plots and cv-root-mean-square tests, was performed. A total of 188 duplicate (376 individual) measurements were collected from 119 infants (88 preterm, 31 term). The median absolute difference between duplicates was 31.5 g for fat-free mass (FFM). Linear correlation analysis showed R2 = 0.97 for FFM. The absolute differences in FFM and fat mass did not significantly correlate with increasing age. The %FFM differed (p = 0.02) across body weight groups of 1 kg < BW ≤ 2 kg (1.8%; IQR: 0.8, 3.6) and BW > 3 kg (0.9%; IQR: 0.3, 2.1). The median absolute differences were 1 g (IQR: 0.4, 3.1) for body weight and 5.6 mL (IQR: 2.1, 11.8) for body volume. Body volume estimation is charged with a constant absolute error, which is the main factor for differences between repeated body composition assessments. This error becomes more prominent in infants with lower body weights. Nevertheless, reproducibility of weekly PEAPOD testing is sufficient to monitor body compartment changes, offering a foundation for nutritional decisions in both preterm and term infants.
Collapse
Affiliation(s)
- Lennart Lücke
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care, and Pediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany; (L.L.)
- Research Department of Child Nutrition, University Hospital of Pediatrics and Adolescent Medicine, St. Josef-Hospital, Ruhr University Bochum, 44791 Bochum, Germany
| | - Christoph Fusch
- Department of Pediatrics, University Hospital Nuremberg, Paracelsus Medical University, Breslauer Str. 201, 90471 Nürnberg, Germany; (C.F.); (K.K.); (S.S.)
- Department of Pediatrics, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Katja Knab
- Department of Pediatrics, University Hospital Nuremberg, Paracelsus Medical University, Breslauer Str. 201, 90471 Nürnberg, Germany; (C.F.); (K.K.); (S.S.)
| | - Stefan Schäfer
- Department of Pediatrics, University Hospital Nuremberg, Paracelsus Medical University, Breslauer Str. 201, 90471 Nürnberg, Germany; (C.F.); (K.K.); (S.S.)
| | - Jasper L. Zimmermann
- Department of Pediatrics, University Hospital Nuremberg, Paracelsus Medical University, Breslauer Str. 201, 90471 Nürnberg, Germany; (C.F.); (K.K.); (S.S.)
| | - Ursula Felderhoff-Müser
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care, and Pediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany; (L.L.)
| | - Anastasia Meis
- Department of Pediatrics, University Hospital Nuremberg, Paracelsus Medical University, Breslauer Str. 201, 90471 Nürnberg, Germany; (C.F.); (K.K.); (S.S.)
| | - Stephanie Lohmüller-Weiß
- Department of Pediatrics, University Hospital Nuremberg, Paracelsus Medical University, Breslauer Str. 201, 90471 Nürnberg, Germany; (C.F.); (K.K.); (S.S.)
| | - Adel Szakacs-Fusch
- Department of Pediatrics, University Hospital Nuremberg, Paracelsus Medical University, Breslauer Str. 201, 90471 Nürnberg, Germany; (C.F.); (K.K.); (S.S.)
| | - Niels Rochow
- Department of Pediatrics, University Hospital Nuremberg, Paracelsus Medical University, Breslauer Str. 201, 90471 Nürnberg, Germany; (C.F.); (K.K.); (S.S.)
- DeuZWEG German Center for Growth, Development and Health Encouragement during Childhood and Youth, 10249 Berlin, Germany
- Department of Pediatrics, University Medicine Rostock, 18057 Rostock, Germany
| |
Collapse
|
2
|
Tortorella CCDS, Chao BMP, Rabito EI, Lima MN, Sarquis ALF. Bioelectrical Impedance in Premature Newborns and Its Relationship with Diet Therapy in a Neonatal Intensive Care Unit. Nutrients 2024; 16:601. [PMID: 38474729 DOI: 10.3390/nu16050601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 02/04/2024] [Accepted: 02/07/2024] [Indexed: 03/14/2024] Open
Abstract
(1) Background: To estimate resistance, reactance, and phase angle values among moderate preterm infants and their variation according to neonatal and maternal characteristics and nutritional intake. (2) Methods: This was a cohort that evaluated 43 moderate preterm infants using bioelectrical impedance analysis. The study variables included resistance, reactance, and phase angle measurements, in addition to classification of nutritional intake. (3) Results: Mean resistance was 602.0 ± 118.2 Ω, reactance was 57.2 Ω (IQR = 42.6-65.2), and phase angle was 522° (IQR = 4.1-6.6). Lower resistance values were found in the presence of risky pregnancy (532.2 ± 111.9 Ω vs. 650.9 ± 97.9 Ω, p < 0.001) and lower reactance values, in the presence of harmful maternal lifestyle habits at both the first (p = 0.01) and second assessments (p = 0.01). Eight preterm infants were considered to have insufficient nutritional intake (23.5%); 17, sufficient (50.0%) and 9, partially sufficient (26.5%). There was less reactance among preterm infants with insufficient nutritional intake (p < 0.001). (4) Conclusions: The bioelectrical impedance analysis measurements were within the range of values reported in other studies. There was an association between full diet and adequate nutritional intake with higher resistance values, while a lower reactance value was associated with the presence of risky pregnancy and harmful maternal lifestyle.
Collapse
Affiliation(s)
- Catiuscie Cabreira da Silva Tortorella
- Graduate Program in Child and Adolescent Health, Department of Pediatrics, Hospital de Clínicas, Federal University of Paraná, Curitiba 80060-900, Brazil
| | | | - Estela Iraci Rabito
- Department of Nutrition, Federal University of Paraná, Curitiba 80060-900, Brazil
| | - Mônica Nunes Lima
- Graduate Program in Child and Adolescent Health, Department of Pediatrics, Hospital de Clínicas, Federal University of Paraná, Curitiba 80060-900, Brazil
| | - Ana Lúcia Figueiredo Sarquis
- Graduate Program in Child and Adolescent Health, Department of Pediatrics, Hospital de Clínicas, Federal University of Paraná, Curitiba 80060-900, Brazil
| |
Collapse
|
3
|
Viswanathan S, McNelis K, Alja'nini Z, Merlino S, Collin M, Groh-Wargo S. Enhancing Interpretation of One-Time Body Composition Measurement at Near-Term Gestation in Preterm Infants: An Exploratory Study. Am J Perinatol 2024; 41:368-372. [PMID: 35973800 DOI: 10.1055/a-1925-1911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
In preterm infants, longitudinal growth patterns have a stronger association with clinical outcomes than cross-sectional metrics. For qualitative growth, a one-time body composition measurement at near term is common, and here we explore the potential use of a novel estimated longitudinal body composition metric (adjusted fat-free mass deficit) using birth anthropometrics. KEY POINTS: · Longitudinal growth patterns are better linked with clinical outcomes in preterm infants.. · Body composition is increasingly used to assess the quality of postnatal growth in preterm infants.. · Single body composition at term adjusted using birth weight may be better predictive for outcomes..
Collapse
Affiliation(s)
- Sreekanth Viswanathan
- Division of Neonatology, Department of Pediatrics, Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando, Florida
| | - Kera McNelis
- Division of Neonatology, Department of Pediatrics, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Zaineh Alja'nini
- Division of Neonatology, Department of Pediatrics, Mercy Kids Children's Hospital, University of Missouri School of Medicine, Springfield, Missouri
| | - Stephanie Merlino
- Department of Pediatrics, MetroHealth Medical Center affiliated with Case Western Reserve University, Cleveland, Ohio
| | - Marc Collin
- Department of Pediatrics, MetroHealth Medical Center affiliated with Case Western Reserve University, Cleveland, Ohio
| | - Sharon Groh-Wargo
- Department of Pediatrics, MetroHealth Medical Center affiliated with Case Western Reserve University, Cleveland, Ohio
| |
Collapse
|
4
|
Hills AP, Norris SA, Byrne NM, Jayasinghe S, Murphy-Alford AJ, Loechl CU, Ismail LIC, Kurpad AV, Kuriyan R, Nyati LH, Santos IS, Costa CS, Wickramasinghe VP, Lucas MN, Slater C, Yameen A, Ariff S. Body composition from birth to 2 years. Eur J Clin Nutr 2023:10.1038/s41430-023-01322-7. [PMID: 37563231 DOI: 10.1038/s41430-023-01322-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 05/08/2023] [Accepted: 07/25/2023] [Indexed: 08/12/2023]
Abstract
Providing all infants with the best start to life is a universal but challenging goal for the global community. Historically, the size and shape of infants, quantified by anthropometry and commencing with birthweight, has been the common yardstick for physical growth and development. Anthropometry has long been considered a proxy for nutritional status during infancy when, under ideal circumstances, changes in size and shape are most rapid. Developed from data collected in the Multicentre Growth Reference Study (MGRS), WHO Child Growth Standards for healthy infants and children have been widely accepted and progressively adopted. In contrast, and somewhat surprisingly, much less is understood about the 'quality' of growth as reflected by body composition during infancy. Recent advances in body composition assessment, including the more widespread use of air displacement plethysmography (ADP) across the first months of life, have contributed to a progressive increase in our knowledge and understanding of growth and development. Along with stable isotope approaches, most commonly the deuterium dilution (DD) technique, the criterion measure of total body water (TBW), our ability to quantify lean and fat tissue using a two-compartment model, has been greatly enhanced. However, until now, global reference charts for the body composition of healthy infants have been lacking. This paper details some of the historical challenges associated with the assessment of body composition across the first two years of life, and references the logical next steps in growth assessments, including reference charts.
Collapse
Affiliation(s)
| | - Shane A Norris
- University of the Witwatersrand, Johannesburg, South Africa
- University of Southampton, Southampton, United Kingdom
| | | | | | | | | | - Leila I Cheikh Ismail
- University of Sharjah, Sharjah, United Arab Emirates
- University of Oxford, Oxford, United Kingdom
| | | | | | | | | | | | | | | | | | - Ayesha Yameen
- Pakistan Institute of Nuclear Science and Technology (PINSTECH), Nilore, Pakistan
| | | |
Collapse
|
5
|
Rodríguez-Cano AM, Piña-Ramírez O, Rodríguez-Hernández C, Mier-Cabrera J, Villalobos-Alcazar G, Estrada-Gutierrez G, Cardona-Pérez A, Coronado-Zarco A, Perichart-Perera O. Development and validation of anthropometric-based fat-mass prediction equations using air displacement plethysmography in Mexican infants. Eur J Clin Nutr 2023; 77:748-756. [PMID: 37055482 PMCID: PMC10335931 DOI: 10.1038/s41430-023-01285-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 03/15/2023] [Accepted: 03/16/2023] [Indexed: 04/15/2023]
Abstract
BACKGROUND/OBJECTIVES Fat-mass (FM) assessment since birth using valid methodologies is crucial since excessive adiposity represents a risk factor for adverse metabolic outcomes. AIM To develop infant FM prediction equations using anthropometry and validate them against air-displacement plethysmography (ADP). SUBJECTS/METHODS Clinical, anthropometric (weight, length, body-mass index -BMI-, circumferences, and skinfolds), and FM (ADP) data were collected from healthy-term infants at 1 (n = 133), 3 (n = 105), and 6 (n = 101) months enrolled in the OBESO perinatal cohort (Mexico City). FM prediction models were developed in 3 steps: 1) Variable Selection (LASSO regression), 2) Model behavior evaluation (12-fold cross-validation, using Theil-Sen regressions), and 3) Final model evaluation (Bland-Altman plots, Deming regression). RESULTS Relevant variables in the FM prediction models included BMI, circumferences (waist, thigh, and calf), and skinfolds (waist, triceps, subscapular, thigh, and calf). The R2 of each model was 1 M: 0.54, 3 M: 0.69, 6 M: 0.63. Predicted FM showed high correlation values (r ≥ 0.73, p < 0.001) with FM measured with ADP. There were no significant differences between predicted vs measured FM (1 M: 0.62 vs 0.6; 3 M: 1.2 vs 1.35; 6 M: 1.65 vs 1.76 kg; p > 0.05). Bias were: 1 M -0.021 (95%CI: -0.050 to 0.008), 3 M: 0.014 (95%CI: 0.090-0.195), 6 M: 0.108 (95%CI: 0.046-0.169). CONCLUSION Anthropometry-based prediction equations are inexpensive and represent a more accessible method to estimate body composition. The proposed equations are useful for evaluating FM in Mexican infants.
Collapse
Affiliation(s)
- Ameyalli M Rodríguez-Cano
- Nutrition and Bioprogramming Coordination, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, CP 11000, Ciudad de México, México
| | - Omar Piña-Ramírez
- Bioinformatics and Statistical Analysis Department, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, CP 11000, Ciudad de México, México
| | - Carolina Rodríguez-Hernández
- Nutrition and Bioprogramming Coordination, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, CP 11000, Ciudad de México, México
| | - Jennifer Mier-Cabrera
- Nutrition and Bioprogramming Coordination, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, CP 11000, Ciudad de México, México
| | - Gicela Villalobos-Alcazar
- Neonatal Ward, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, CP 11000, Ciudad de México, México
| | - Guadalupe Estrada-Gutierrez
- Research Division, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, CP 11000, Ciudad de México, México
| | - Arturo Cardona-Pérez
- General Director, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, CP 11000, Ciudad de México, México
| | - Alejandra Coronado-Zarco
- Neonatology Division, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, CP 11000, Ciudad de México, México
| | - Otilia Perichart-Perera
- Nutrition and Bioprogramming Coordination, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, CP 11000, Ciudad de México, México.
| |
Collapse
|
6
|
Martins BMR, de Abranches AD, Méio MDBB, Gomes-Junior SCS, Moreira MEL. Early growth and body composition assessed by air displacement plethysmography in infants born with simple gastroschisis. J Pediatr Surg 2023; 58:741-746. [PMID: 36588037 DOI: 10.1016/j.jpedsurg.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 10/29/2022] [Accepted: 11/17/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Gastroschisis is an abdominal wall malformation usually associated with impaired growth. OBJECTIVE To evaluate the growth and body composition of infants born with simple gastroschisis in a referral center. METHODS This was a single-center, prospective case series of infants with simple gastroschisis who were measured at birth, at discharge, and at 3 months. Body composition was assessed via air-displacement plethysmography at discharge and at 3 months. The results were compared with those reported for healthy infants at an equivalent gestational age. RESULTS Simple gastroschisis infants were lighter and smaller at birth and remained similar at 3 months. All anthropometric z scores decreased from birth to discharge, followed by an increase but not a full recovery toward 3 months. Overall, gastroschisis infants had a similar FM percentage, FM% (11.1 ± 4.7), but a lower FFM, FFM (2481 ± 478 g), at discharge. FM% (18.5 ± 5.3) decreased at 3 months, and FFM remained lower (3788 ± 722 g) but improved between the two exams. Boys had significantly more FFM than girls at both evaluations. The multiple regression analysis showed that male sex, prematurity, total parenteral nutrition duration, and exclusive breast milk diets were associated with differences in body composition. CONCLUSIONS Infants with simple gastroschisis cared for in a referral center experienced growth failure at discharge and showed a similar FM% but lower FFM than healthy infants. At 3 months, they exhibited smaller FM% and FFM, but FFM improved after the first exam, representing a better protein accretion. TYPE OF STUDY Prognostic. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Bianca M R Martins
- Department of Surgery, Surgical NICU, Instituto Fernandes Figueira - Fundação Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, Brazil.
| | - Andrea Dunshee de Abranches
- Clinical Research Unit, Instituto Fernandes Figueira - Fundação Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, Brazil
| | - Maria D B B Méio
- Clinical Research Unit, Instituto Fernandes Figueira - Fundação Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, Brazil
| | - Saint Clair S Gomes-Junior
- Clinical Research Unit, Instituto Fernandes Figueira - Fundação Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, Brazil
| | - Maria E L Moreira
- Clinical Research Unit, Instituto Fernandes Figueira - Fundação Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, Brazil
| |
Collapse
|
7
|
The association between BMI trajectories and bronchopulmonary dysplasia among very preterm infants. Pediatr Res 2022; 93:1609-1615. [PMID: 36414708 DOI: 10.1038/s41390-022-02358-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 10/01/2022] [Accepted: 10/09/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To investigate the association between change in body mass index (BMI) from birth to 36 weeks gestation (ΔBMI) and bronchopulmonary dysplasia (BPD) among infants born <30 weeks gestation. METHODS This was a multicenter retrospective cohort study (2015-2018) of infants born <30 weeks gestation and alive at ≥34 weeks corrected. Main exposure was a change in BMI z score from birth to 36 weeks corrected age grouped into quartiles of change. Association between ΔBMI z scores and BPD was assessed using generalized linear mixed models. RESULTS Among 772 included infants, 51% developed BPD. From birth to 36 weeks CGA, the weight z score of infants with BPD decreased less than for BPD-free infants, despite a greater decrease in length z score and similar caloric intake resulting in increases in BMI z score (median [IQR], 0.16 [-0.64; 1.03] vs -0.29 [-1.03; 0.49]; P < 0.01). In the adjusted analysis, higher ΔBMI z score quartiles were associated with higher odds of BPD (Q3 vs Q2, AOR [95% CI], 2.02 [1.23; 3.31] and Q4 vs Q2, AOR [95% CI], 2.00 [1.20; 3.34]). CONCLUSION Among preterm infants, an increase in BMI z score from birth to 36 weeks corrected is associated with higher odds of BPD. IMPACT Preterm infants with evolving lung disease often experience disproportionate growth in the neonatal period. In this multicenter cohort study, increases in BMI z score from birth to 36 weeks CGA were associated with higher odds of BPD. Despite similar caloric intake, infants with BPD had a higher weight- but lower length-for-age, resulting in higher BMI z score compared to BPD-free infants. This suggests that infants with evolving BPD may require different growth and nutritional targets compared to BPD-free infants.
Collapse
|
8
|
Lach LE, Chetta KE, Ruddy-Humphries AL, Ebeling MD, Gregoski MJ, Katikaneni LD. Body Composition and "Catch-Up" Fat Growth in Healthy Small for Gestational Age Preterm Infants and Neurodevelopmental Outcomes. Nutrients 2022; 14:3051. [PMID: 35893903 PMCID: PMC9332383 DOI: 10.3390/nu14153051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/08/2022] [Accepted: 07/22/2022] [Indexed: 11/25/2022] Open
Abstract
To examine the growth and body composition of small for gestational age (SGA) and appropriate for gestational age (AGA) very low birth weight infants (VLBW) and their outpatient neurodevelopmental outcomes. From 2006-2012, VLBW infants (n = 57 of 92) admitted to the Neonatal Intensive Care Unit (NICU) had serial air displacement plethysmography (ADP) scans and were followed as outpatients. Serial developmental testing (CAT/CLAMS, Peabody Gross Motor Scales) and anthropometrics were obtained from n = 37 infants (29 AGA and 8 SGA) and analyzed via repeated measures analyses of variances. The percentage of body fat, percentage of lean mass, and weight gain were statistically significant between SGA and AGA groups at the first ADP assessment. There was no difference between the two groups in outpatient neurodevelopmental testing. Weight gain as "catch-up" body fat accrual occurs by 67 weeks of PMA. This catch-up growth is associated with normal SGA preterm neurodevelopment as compared to AGA preterm infants.
Collapse
Affiliation(s)
- Laura E. Lach
- Division of Neonatology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC 29425, USA; (K.E.C.); (A.L.R.-H.); (M.D.E.); (L.D.K.)
| | - Katherine E. Chetta
- Division of Neonatology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC 29425, USA; (K.E.C.); (A.L.R.-H.); (M.D.E.); (L.D.K.)
| | - Amy L. Ruddy-Humphries
- Division of Neonatology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC 29425, USA; (K.E.C.); (A.L.R.-H.); (M.D.E.); (L.D.K.)
| | - Myla D. Ebeling
- Division of Neonatology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC 29425, USA; (K.E.C.); (A.L.R.-H.); (M.D.E.); (L.D.K.)
| | - Mathew J. Gregoski
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC 29425, USA;
| | - Lakshmi D. Katikaneni
- Division of Neonatology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC 29425, USA; (K.E.C.); (A.L.R.-H.); (M.D.E.); (L.D.K.)
| |
Collapse
|
9
|
Toledo LFM, Medeiros TR, Vieira AA, Coca Velarde LG. Evaluation of the bioimpedance technique in newborns with a focus on electrode positioning: A prospective, randomized, crossover study. Nutr Clin Pract 2022; 37:1458-1463. [PMID: 35710695 DOI: 10.1002/ncp.10879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 05/03/2022] [Accepted: 05/21/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Bioelectrical impedance analysis (BIA) is a good alternative for assessing total body water in newborns. However, the lack of standardization of the method for its use in the neonatal population raises doubts about its reliability and external validation. OBJECTIVE To compare resistance (R) and reactance (Xc) values measured by BIA with electrodes placed in the anatomical position and with electrodes placed at 5-cm intervals. METHOD Prospective, randomized, crossover study, in which R and Xc values were measured using monofrequency BIA. The choice of the first position of the electrodes to be analyzed in each NB was performed by a simple randomization, and subsequent measurements were performed in rapid succession. The calculated sample size was 203 evaluations. The paired t test was used to compare the means of R and Xc, and the Bland-Altman plot and linear regression were used to analyze how much the measured values were influenced by the electrode position. RESULTS Significant differences were found in the R (855.25 ± 147.79 vs 618.95 ± 93.28 Ω) and Xc (50.94 ± 17.34 vs 39.76 ± 18.35 Ω) values measured with electrodes in the anatomical position and at 5-cm intervals, respectively. The electrodes in the anatomical position produced R and Xc values 37.7% and 16.6%, respectively, higher on average when compared with 5-cm intervals. CONCLUSIONS The distance between the electrodes influences the measurement of R and Xc by BIA. These results highlight the importance of defining a standard for the placement of electrodes in newborns for the use of these measures in neonatal clinical practice.
Collapse
Affiliation(s)
- Luana F M Toledo
- Maternal and Child Department, Federal Fluminense University, Niterói, Rio de Janeiro, Brazil
| | - Thatyana R Medeiros
- Maternal and Child Department, Federal Fluminense University, Niterói, Rio de Janeiro, Brazil
| | - Alan A Vieira
- Maternal and Child Department, Federal Fluminense University, Niterói, Rio de Janeiro, Brazil
| | | |
Collapse
|
10
|
Nagel EM, Hickey M, Teigen LM, Kuchnia A, Schifsky H, Holm T, Earthman CP, Demerath E, Ramel SE. Ultrasound measurements of abdominal muscle thickness are associated with postmenstrual age at full oral feedings in preterm infants: A preliminary study. Nutr Clin Pract 2021; 36:1207-1214. [PMID: 34101241 DOI: 10.1002/ncp.10670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 03/30/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A premature infant's discharge from the neonatal intensive care unit (NICU) is dependent on factors such as respiratory stability, adequate growth, and the ability to consume oral feeds. Once infants have achieved respiratory stability, a tool that can better predict age at discharge is desirable. Thus, we conducted a secondary data analysis to assess the association between ultrasound measurements of abdominal muscle thickness and postmenstrual age (PMA) at full oral feedings. METHODS Forty-nine (n = 49) healthy, premature infants (mean gestational age = 32 weeks) were recruited from the NICU. Anthropometric measurements and ultrasound measurements of the rectus abdominis were conducted when infants were medically stable. Fat-free mass (FFM) was obtained using air displacement plethysmography. The relationship between ultrasound measurements of muscle thickness and PMA at full oral feedings was assessed using linear regression analysis. The relationship between FFM z-scores and PMA at full oral feedings was also assessed for comparison. RESULTS When adjusting for gestational age at birth, PMA at measurement, days of positive pressure respiratory support, weight, and length, ultrasound measurements of abdominal muscle thickness were independently, negatively associated with PMA at full oral feedings (β estimate: -0.71, P = .03). CONCLUSION Preliminary results suggest infants with greater abdominal muscle thickness may reach full oral feedings at an earlier PMA (nearly 1 week per millimeter). Thus, ultrasound measurements of abdominal muscle thickness may be helpful in assessing readiness for discharge in healthy preterm infants. Further research is needed for development and validation of a prediction equation.
Collapse
Affiliation(s)
- Emily M Nagel
- Department of Food Science and Nutrition, University of Minnesota-Twin Cities, Minneapolis, Minnesota, USA.,School of Public Health, University of Minnesota-Twin Cities, Minneapolis, Minnesota, USA
| | - Marie Hickey
- Department of Pediatrics, University of Minnesota-Twin Cities, Minneapolis, Minnesota, USA
| | - Levi M Teigen
- Department of Gastroenterology, University of Minnesota-Twin Cities, Minneapolis, Minnesota, USA
| | - Adam Kuchnia
- Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Holly Schifsky
- Department of Pediatrics, University of Minnesota-Twin Cities, Minneapolis, Minnesota, USA
| | - Tara Holm
- Department of Radiology, University of Minnesota-Twin Cities, Minneapolis, Minnesota, USA
| | - Carrie P Earthman
- Department of Behavioral Health and Nutrition, University of Delaware, Newark, Delaware, USA
| | - Ellen Demerath
- School of Public Health, University of Minnesota-Twin Cities, Minneapolis, Minnesota, USA
| | - Sara E Ramel
- Department of Pediatrics, University of Minnesota-Twin Cities, Minneapolis, Minnesota, USA
| |
Collapse
|
11
|
Body adiposity and oral feeding outcomes in infants: a pilot study. J Perinatol 2021; 41:1059-1064. [PMID: 33597738 DOI: 10.1038/s41372-021-00975-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 12/04/2020] [Accepted: 01/27/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Prevalence of oral feeding difficulties in high-risk infants is increasing. Desire to take orally can be influenced by hunger and satiety, which may influence growth and body fat. OBJECTIVE To determine the association between body adiposity and infant oral feeding. METHODS Retrospective case-control study of infants ≥37-week postmenstrual age (PMA). Infants on tube feeding (cases) compared to birth gestation-matched infants on full oral feeding (controls). Body composition was determined by air displacement plethysmography. RESULTS Overall, 16 cases vs. 16 controls. At study, cases vs. controls had similar PMA, weight and length z-scores, and calorie intake. The mean oral intake was significantly less in cases vs. controls (66 vs. 168 ml/kg/day, p < 0.001). Cases had significantly higher percentage of fat mass (18.7 vs. 10.9) and fat-mass z-score (1.62 vs. 0.08) (p < 0.05), but similar fat-free mass vs. controls. Five case infants required gastrostomy. CONCLUSIONS Higher body adiposity may worsen the infant oral feeding outcomes.
Collapse
|
12
|
Alja'nini Z, McNelis KM, Viswanathan S, Goddard GR, Merlino-Barr S, Collin M, Groh-Wargo S. Infant body composition assessment in the neonatal intensive care unit (NICU) using air displacement plethysmography: Strategies for implementation into clinical workflow. Clin Nutr ESPEN 2021; 43:212-222. [PMID: 34024517 DOI: 10.1016/j.clnesp.2021.04.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 04/03/2021] [Accepted: 04/10/2021] [Indexed: 11/19/2022]
Abstract
Nutritional management is integral to infant care in the neonatal intensive care unit (NICU). Recent research on body composition that specifically evaluated fat and fat-free mass has improved our understanding of infant growth and nutritional requirements. The need for body composition monitoring in infants is increasingly recognized as changes in fat mass and fat-free mass associated with early growth can impact clinical outcomes. With the availability of air displacement plethysmography (ADP) as a noninvasive method for assessing infant body composition and published normative gestational age- and sex-specific body composition curves, it is justifiable to integrate this innovation into routine clinical care. Here we describe our experiences in implementing body composition measurement using ADP in routine clinical care in different NICU settings.
Collapse
Affiliation(s)
- Zaineh Alja'nini
- Department of Pediatrics, MetroHealth Medical Center Affiliated with Case Western Reserve University, Cleveland, OH, USA.
| | - Kera Michelle McNelis
- Cincinnati Children's Hospital Medical Center, Department of Pediatrics, Perinatal Institute, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Sreekanth Viswanathan
- Division of Neonatology, Department of Pediatrics, Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando, FL, USA
| | - Gillian R Goddard
- Division of Pediatric and General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Stephanie Merlino-Barr
- Department of Pediatrics, MetroHealth Medical Center Affiliated with Case Western Reserve University, Cleveland, OH, USA
| | - Marc Collin
- Department of Pediatrics, MetroHealth Medical Center Affiliated with Case Western Reserve University, Cleveland, OH, USA
| | - Sharon Groh-Wargo
- Department of Pediatrics, MetroHealth Medical Center Affiliated with Case Western Reserve University, Cleveland, OH, USA
| |
Collapse
|
13
|
Parat S, Raza P, Kamleh M, Super D, Groh-Wargo S. Targeted Breast Milk Fortification for Very Low Birth Weight (VLBW) Infants: Nutritional Intake, Growth Outcome and Body Composition. Nutrients 2020; 12:nu12041156. [PMID: 32326177 PMCID: PMC7230830 DOI: 10.3390/nu12041156] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 04/09/2020] [Accepted: 04/17/2020] [Indexed: 01/09/2023] Open
Abstract
Despite improvements in nutritional management, preterm infants continue to face high rates of postnatal growth restriction. Because variability in breast milk composition may result in protein and energy deficits, targeted fortification has been advocated. We conducted an interventional study to compare body composition and growth outcomes of very low birth weight infants fed targeted protein-fortified human milk (HM) with those fed standard fortified HM. If mother’s own milk was not available, donor milk was used. Weekly analysis of HM with mid-infrared spectroscopy was conducted and additional protein was added to the fortified HM to ensure a protein intake of 4 g/kg/day. Weekly anthropometric measurements were done. Prior to discharge or at 37 weeks, corrected age skinfold thickness (SFT) measurements as well as body composition measurement using air displacement plethysmography were done. Among 36 preterm infants enrolled, those in the targeted group (n = 17) received more protein and had a larger flank SFT at study end than those in the standard group (n = 19). A pilot post-hoc analysis of subjects having at least 30 intervention days showed a 3% higher fat-free mass in the targeted group. Use of a targeted fortification strategy resulted in a higher protein intake and fat-free mass among those receiving longer intervention.
Collapse
Affiliation(s)
- Sumesh Parat
- Department of Pediatrics at MetroHealth Medical Center, Cleveland, OH 44109, USA; (D.S.); (S.G.-W.)
- Department of Pediatrics at Texas Tech University Health Sciences Center, Amarillo, TX 79106, USA
- Correspondence: ; Tel.: +806-414-9575
| | - Praneeta Raza
- Neurological Institute, Cleveland Clinic, Cleveland, OH 44106, USA;
| | - May Kamleh
- Health Economics and Outcomes Research, Covance Market Access, Houston, TX 77018, USA;
| | - Dennis Super
- Department of Pediatrics at MetroHealth Medical Center, Cleveland, OH 44109, USA; (D.S.); (S.G.-W.)
| | - Sharon Groh-Wargo
- Department of Pediatrics at MetroHealth Medical Center, Cleveland, OH 44109, USA; (D.S.); (S.G.-W.)
| |
Collapse
|