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Young A, Brown LK, Ennis S, Beattie RM, Johnson MJ. Total body water in full-term and preterm newborns: systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed 2021; 106:542-548. [PMID: 33789970 DOI: 10.1136/archdischild-2020-321112] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 02/07/2021] [Accepted: 03/12/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Total body water (TBW) is one component of fat-free mass and changes in TBW are influenced by fluid shifts (especially during transition to postnatal life), electrolyte balance and nutritional status. Normal values for term-born neonates and preterm infants at birth have not been defined in large cohorts, limiting investigation into its monitoring and use in clinical practice. OBJECTIVE To systematically review the evidence base for percentage of TBW in term-born infants, quantify the effect of prematurity on TBW at birth, and describe normal progression of TBW over time in preterm infants. METHODS Systematic review of Medline, Web of Science Core Collection and EBSCO-CINAHL (January 1946 to January 2020). Included articles used dilutional methods to assess TBW. RESULTS Searches identified 2349 articles of which 22 included data suitable for analysis. Mean TBW in term-born newborns was 73.8% (95% CI 72.47% to 75.06%, 15 studies, 433 infants). Meta-regression showed that TBW was higher in preterm infants (up to 90% at 26 weeks gestation, dropping to 75% at 36 weeks corrected gestation) and was negatively correlated with gestation at birth, falling 1.44% per week (95% CI 0.63% to 2.24%, 9 studies, 179 infants). Analysis of TBW over time during the ex utero growth of preterm infants was not possible due to paucity of data. CONCLUSION This review defines the normal TBW percentage in term-born infants and confirms and quantifies previous findings that preterm infants have a higher TBW percentage.
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Affiliation(s)
- Aneurin Young
- Department of Neonatal Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, UK .,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Lisa K Brown
- Department of Neonatal Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Sarah Ennis
- Human Genetics and Genomic Medicine, University of Southampton, Southampton, UK
| | - R Mark Beattie
- Department of Paediatric Gastroenterology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Mark John Johnson
- Department of Neonatal Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Olsen IE, Lawson ML, Meinzen-Derr J, Sapsford AL, Schibler KR, Donovan EF, Morrow AL. Use of a body proportionality index for growth assessment of preterm infants. J Pediatr 2009; 154:486-91. [PMID: 19041096 PMCID: PMC2745983 DOI: 10.1016/j.jpeds.2008.10.012] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2006] [Revised: 09/12/2008] [Accepted: 10/07/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To evaluate the utility of weight-for-length (defined as gm/cm(3), known as the "ponderal index") as a complementary measure of growth in infants in neonatal intensive care units (NICUs). STUDY DESIGN This was a secondary analysis of infants (n=1214) of gestational age 26 to 29 weeks at birth, included in a registry database (1991-2003), who had growth data at birth and discharge. Weight-for-age and weight-for-length were categorized as small (<10th percentile), appropriate, or large (>90th percentile). RESULTS Statistical agreement between the weight-for-age and weight-for-length measures was poor (kappa=0.02 at birth, 0.10 at discharge; Bowker test for symmetry, P< .0001). From birth to discharge, the percentage of small-for-age infants increased from 12% to 21%, the percentage of small-for-length infants decreased from 10% to 4%, the percentage of large-for-age infants remained similar (<1%), and the percentage of large-for-length infants increased from 5% to 17%. At discharge, 92% of the small-for-age infants were appropriate or large-for-length, and 19% of the appropriate-for-age infants were large-for-length. CONCLUSIONS Weight-for-age and weight-for-length are complementary measures. Weight-for-length or other measures of body proportionality should be considered for inclusion in routine growth monitoring of infants in the NICU.
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Affiliation(s)
- Irene E. Olsen
- Center for Epidemiology and Biostatistics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, Division of Neonatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, The Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, Department of Bioscience and Biotechnology, College of Arts and Sciences, Drexel University, Philadelphia, PA
| | - M. Louise Lawson
- Center for Epidemiology and Biostatistics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, The Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, Department of Mathematics and Statistics, Kennesaw State University, Kennesaw, GA
| | - Jareen Meinzen-Derr
- Center for Epidemiology and Biostatistics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, Division of Neonatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Amy L. Sapsford
- Regional Center for Newborn Intensive Care, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Kurt R. Schibler
- Division of Neonatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, The Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Edward F. Donovan
- Division of Neonatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, The Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Ardythe L. Morrow
- Center for Epidemiology and Biostatistics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, Division of Neonatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, The Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
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Abstract
The ever-increasing survival of premature and extremely low birth weight infants has posed a great challenge to neonatologists and nutritionists. While nutrient requirements are still being defined, there is a great need to continue to improve our strategies for providing effective nutrition for these infants. Similarly, postdischarge nutritional issues need to be addressed since catch-up growth does not always occur. In addition to fetal origins of adult diseases, especially cardiovascular disorders, diabetes and obesity, new data are emerging that postnatal growth alterations also affect these same disorders. However, as we learn more about the latter issues, one needs to be cautious about abandoning our current practices in providing optimal nutrition.
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Affiliation(s)
- Jatinder Bhatia
- Section of Neonatology, Department of Pediatrics, Medical College of Georgia, 30912, USA
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Bhatia J, Rassin DK, Cerreto MC, Bee DE. Effect of protein/energy ratio on growth and behavior of premature infants: preliminary findings. J Pediatr 1991; 119:103-10. [PMID: 2066840 DOI: 10.1016/s0022-3476(05)81048-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Premature infants weighing less than 1550 gm at birth were randomly assigned to receive one of three formulas identical in composition except for protein content (2.2, 2.7, and 3.2 gm.100 kcal-1) to determine the effects on growth, protein nutritional status, and behavior. Data collected for 2 weeks from the time of achieving an enteral energy intake of 100 kcal.kg-1.day-1 included measurements of weight, length, head circumference, and skin-fold thickness, and concentrations of plasma amino acids, serum total protein, prealbumin, retinol-binding protein, and urea nitrogen. In a subset of infants, behavior was assessed at the end of the feeding study with the Neonatal Behavior Assessment Scale. Except for the concentrations of plasma amino acids, there were no significant differences in growth or in other biochemical measurements among the three groups, but there were significant differences in the orientation, habituation, and stability clusters of the behavior assessment. Further, there were significant correlations between the plasma amino acid values and the behavioral clusters. These preliminary data suggest a relationship between protein intake in the neonatal period and behavioral outcome at the end of the feeding period in the absence of differences in growth and gross markers of protein nutritional status. The behavioral items noted to differ among the groups may indicate later cognitive outcome; detailed studies about behavioral responses to neonatal dietary intakes and later outcome seem indicated.
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Affiliation(s)
- J Bhatia
- Department of Pediatrics, University of Texas Medical Branch, Galveston 77550
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