Greater Early Gains in Fat-Free Mass, but Not Fat Mass, Are Associated with Improved Neurodevelopment at 1 Year Corrected Age for Prematurity in Very Low Birth Weight Preterm Infants

doi:10.1016/j.jpeds.2016.03.003

The Journal of Pediatrics

Volume 173, June 2016, Pages 108-115

https://doi.org/10.1016/j.jpeds.2016.03.003 Get rights and content

Objective

This work investigates the relationship between early body composition changes and neurodevelopment at 1 year age corrected for prematurity (CA).

Study design

A prospective, longitudinal study to measure body composition weekly in 34 very low birth weight preterm infants using air displacement plethysmography, beginning when infants stabilized after birth until discharge. Neurodevelopmental testing (Bayley Scales of Infant Development-III) was performed at 12 months CA. Linear mixed effects models were used to obtain inpatient subject-specific changes in fat-free mass (FFM) and fat mass (FM), which were then used as predictors of Bayley subscale scores in subsequent linear regression models, adjusting for potential confounders. Protein and energy provision were calculated for the first week of life.

Results

Greater FFM gains while inpatient were associated with improved cognitive and motor scores at 12 months CA (P = .002 for both). These relationships remained significant when adjusting for birth weight, gestational age, and intraventricular hemorrhage (P ≤ .05 for both). Similar analysis was performed for FM gains without significant findings. Increased provision of protein and calories during the first week of life was positively associated with FFM gains (P ≤ .01 for both), but not FM gains (P ≥ .2 for both), throughout hospitalization.

Conclusions

Increased FFM gains, but not FM gains, during hospitalization are associated with improved neurodevelopment at 12 months CA. As early FM gains may be associated with long-term risk, more research is needed to develop strategies that optimize FFM gains while minimizing FM gains in very low birth weight preterm infants.

Section snippets

Methods

Fifty-five infants were recruited from the neonatal intensive care unit (NICU) of the University of Minnesota Masonic Children's Hospital from April 2011 to November 2012. Inclusion criteria included birth weight <1500 g and appropriate for gestational age status (between the 3rd and 97th percentile at birth on the Fenton Growth Curve).¹⁵ During the recruitment period, 176 infants weighing <1500 g at birth were admitted to the NICU. Of those excluded or declined, 10 were small for gestational

Results

Birth characteristics and data on hospital course are documented in Table I. There were differences noted between those who underwent developmental testing and those who did not. Those who underwent testing were born earlier (27.4 [2.6] vs 28.8 [1.9] weeks; P = .05) and remained inpatient longer (78.8 [31.2] vs 57.1 [21.8] days; P = .01; data not shown). Their growth velocities were similar in both FFM and FM gains (P = .09 and .6 respectively; data not shown).

The Figure represents gains in FFM

Discussion

Improved weight gain and linear growth are both associated with better neurodevelopmental outcomes in VLBW preterm infants.1, 2, 5, 6, 7 This study suggests that FFM, but not FM gains, before hospital discharge are associated even more strongly with improved cognitive and motor outcomes in VLBW preterm infants than weight gain alone. This knowledge is potentially important in the management of nutrition in preterm infants as more research becomes available documenting altered body composition

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: Supported by the University of Minnesota Foundation (Amplatz Scholar Award). The authors declare no conflicts of interest.

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Original ArticleGreater Early Gains in Fat-Free Mass, but Not Fat Mass, Are Associated with Improved Neurodevelopment at 1 Year Corrected Age for Prematurity in Very Low Birth Weight Preterm Infants

Objective

Study design

Results

Conclusions

Section snippets

Methods

Results

Discussion

J Pediatr

Am J Clin Nutr

Clin Nutr

J Pediatr

Am J Clin Nutr

Am J Clin Nutr

Am J Clin Nutr

Early Hum Dev

Am J Clin Nutr

J Pediatr

The relationship of poor linear growth velocity with neonatal illness and two year neurodevelopment in preterm infants

Neonatology

Body composition changes in preterm infants following hospital discharge: comparison with term infants

J Pediatr Gastroenterol Nutr

Preterm birth and body composition at term equivalent age: a systematic review and meta-analysis

Pediatrics

Growth in the neonatal intensive care unit influences neurodevelopmental and growth outcomes of extremely low birth weight infants

Pediatrics

Intrauterine, early neonatal and postdischarge growth and neurodevelopmental outcome at 5.4 years in extremely preterm infants after intensive nutritional support

Pediatrics

Original Article
Greater Early Gains in Fat-Free Mass, but Not Fat Mass, Are Associated with Improved Neurodevelopment at 1 Year Corrected Age for Prematurity in Very Low Birth Weight Preterm Infants