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Fenton TR, Barr SM, Elmrayed S, Alshaikh B. Expected and Desirable Preterm and Small Infant Growth Patterns. Adv Nutr 2024:100220. [PMID: 38670164 DOI: 10.1016/j.advnut.2024.100220] [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: 02/10/2024] [Revised: 03/29/2024] [Accepted: 04/02/2024] [Indexed: 04/28/2024] Open
Abstract
Adequate nutrition is necessary for achieving optimal growth and neurodevelopment. Growth is a natural and expected process that happens concomitantly with rapid advancements in neurodevelopment. Serial weight, length, and head circumference growth measures are essential for monitoring development, although identifying pathological deviations from normal growth can pose challenges. Appropriate growth assessments require considerations that a range of sizes for length, head circumference, and weight are expected and appropriate. Because of genetic differences and morbidities, there is a considerable overlap between the growth of healthy infants and those with growth alterations. Parents tend to be over-concerned about children who plot low on growth charts and often need reassurance. Thus, the use of terms such as "poor" growth or growth "failure" are discouraged when growth is approximately parallel to growth chart curves even if their size is smaller than specific percentiles. No specific percentile should be set as a growth goal; individual variability should be expected. An infant's size at birth is important information that goes beyond the common use of prognostic predictions of appropriate compared with small or large for gestational age. The lower the birthweight, the lower the nutrient stores and the more important the need for nutrition support. Compared to term infants, preterm infants at term-equivalent age have a higher percentage of body fat, but this diminishes over the next months. Current research findings support expert recommendations that preterm infants should grow, after early postnatal weight loss, similar to the fetus and then term-born infants, which translates to growth approximately parallel to growth chart curves. There is no need for a trade-off between optimum cognition and optimum future health. Each high-risk infant needs individualized nutrition and growth assessments. This review aims to examine infant growth expectations and messaging for parents of preterm and term-born infants within the broader causal framework.
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Affiliation(s)
- Tanis R Fenton
- Community Health Sciences, O'Brien Institute of Public Health, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada.
| | | | - Seham Elmrayed
- Community Health Sciences, O'Brien Institute of Public Health, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada; Institute of Global Health and Human Ecology, American University in Cairo, Egypt
| | - Belal Alshaikh
- Community Health Sciences, O'Brien Institute of Public Health, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada; Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada
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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..
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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
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Body composition measurement for the preterm neonate: using a clinical utility framework to translate research tools into clinical care. J Perinatol 2022; 42:1550-1555. [PMID: 36203085 PMCID: PMC9617782 DOI: 10.1038/s41372-022-01529-9] [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: 05/28/2022] [Revised: 09/23/2022] [Accepted: 09/26/2022] [Indexed: 11/08/2022]
Abstract
Body composition analysis to distinguish between fat mass and fat-free mass is an established research approach to assess nutritional status. Within neonatal medicine, preterm infant body composition is linked with later health outcomes including neurodevelopment and cardiometabolic health. Mounting evidence establishing fat-free mass as an indicator of nutritional status, coupled with the availability of testing approaches that are feasible to use in preterm infants, have enhanced interest in measuring body composition in the neonatal intensive care unit (NICU) setting. In this paper, we use the concept of clinical utility-the added value of a new methodology over current standard care-as a framework for assessing several existing body composition methodologies with potential for clinical application to preterm neonates. We also use this framework to identify remaining knowledge gaps and prioritize efforts to advance our understanding of clinically-oriented body composition testing in the NICU.
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McNelis K, Poindexter A, Goddard G, Riddle S, Wessel J, Helmrath M. Body Composition of Infants With Congenital Gastroschisis. J Pediatr Gastroenterol Nutr 2022; 74:e35-e38. [PMID: 34406999 DOI: 10.1097/mpg.0000000000003288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
ABSTRACT Infants born with congenital gastroschisis are at risk for intrauterine growth restriction, small for gestational size at birth, and growth failure during the newborn period despite advanced care. Body composition provides a more complete picture of proportional growth than weight and length alone. Fat-free mass (FFM) represents organ growth, and in preterm infants without gastroschisis, improved FFM deposition is associated with improved neurodevelopmental outcomes. There is limited literature regarding the body composition of infants with gastroschisis. This case series describes the body composition of 10 infants with gastroschisis.
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Affiliation(s)
- Kera McNelis
- Division of Neonatology, Cincinnati Children's Hospital Medical Center
- College of Medicine, University of Cincinnati
| | | | - Gillian Goddard
- Division of Pediatric and General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
- Department of Surgery, Boston Medical Center, Boston, MA
| | - Stefanie Riddle
- Division of Neonatology, Cincinnati Children's Hospital Medical Center
- College of Medicine, University of Cincinnati
| | - Jacqueline Wessel
- Division of Pediatric and General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Michael Helmrath
- College of Medicine, University of Cincinnati
- Division of Pediatric and General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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Alja'nini Z, Merlino-Barr S, Brumfiel A, McNelis K, Viswanathan S, Collin M, Groh-Wargo S. Effect of parenteral nutrition duration on patterns of growth and body composition in very low-birth-weight premature infants. JPEN J Parenter Enteral Nutr 2021; 45:1673-1682. [PMID: 34638161 DOI: 10.1002/jpen.2278] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Parenteral nutrition (PN) is essential to support premature infants' growth and varies with enteral nutrition (EN) advancement rates. Data on PN duration's impact on premature infants' growth are limited. The aim of this multicenter observational study was to determine the effect of early PN duration on body composition at term corrected gestational age (CGA) in very low-birth-weight (VLBW) premature infants. METHODS VLBW infants exposed to PN in the first week of life and exposed to significantly different EN regimens were divided into two groups on the basis of early PN duration. Infants with a birth weight (BW) <1000 g and PN duration <28 days and infants with a BW 1000-1500 g and PN duration <14 days were assigned to the "short-PN" group. Infants receiving PN for longer durations were assigned to the "long-PN" group. Body composition was assessed via air displacement plethysmography at term CGA or before discharge. RESULTS Sixty-two and 53 infants were assigned to the short-PN and long-PN groups, respectively. The two groups were significantly different in BW and GA, so a nested case-control study was conducted after matching 36 infant pairs. Infants in the long-PN group had significantly lower fat-free mass (FFM) z-scores, but both groups had comparable fat mass (FM) z-scores. Long PN was a significant negative predictor of FFM z-score in the multivariate regression analysis. CONCLUSION In VLBW premature infants, PN duration is negatively associated with FFM z-scores at term CGA without affecting FM z-scores.
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Affiliation(s)
- Zaineh Alja'nini
- Department of Pediatrics, MetroHealth Medical Center affiliated with Case Western Reserve University, Cleveland, Ohio, USA
| | - Stephanie Merlino-Barr
- Department of Pediatrics, MetroHealth Medical Center affiliated with Case Western Reserve University, Cleveland, Ohio, USA
| | - Alexa Brumfiel
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Kera McNelis
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Sreekanth Viswanathan
- Division of Neonatology, Department of Pediatrics, Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando, Florida, USA
| | - Marc Collin
- Department of Pediatrics, MetroHealth Medical Center affiliated with Case Western Reserve University, Cleveland, Ohio, USA
| | - Sharon Groh-Wargo
- Department of Pediatrics, MetroHealth Medical Center affiliated with Case Western Reserve University, Cleveland, Ohio, USA
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