Abstract
To optimize infant nutrition, the nature of weight gain must be analyzed. This study aims to review publications and develop growth charts for fat and fat-free mass for preterm and term infants. Body composition data measured by air displacement plethysmography (ADP) and dual energy X-ray absorptiometry (DXA) in preterm and term infants until six months corrected age were abstracted from publications (31 December 1990 to 30 April 2019). Age-specific percentiles were calculated. ADP measurements were used in 110 studies (2855 preterm and 22,410 term infants), and DXA was used in 28 studies (1147 preterm and 3542 term infants). At term age, preterm infants had higher percent-fat than term-born infants (16% vs. 11%, p < 0.001). At 52 weeks postmenstrual age (PMA), both reached similar percent-fat (24% vs. 25%). In contrast, at term age, preterm infants had less fat-free mass (2500 g vs. 2900 g) by 400 g. This difference decreased to 250 g by 52 weeks, and to 100 g at 60 weeks PMA (5000 g vs. 5100 g). DXA fat-free mass data were comparable with ADP. However, median percent-fat was up to 5% higher with DXA measurements compared with ADP with PMA > 50 weeks. There are methodological differences between ADP and DXA measures for infants with higher fat mass. The cause of higher fat mass in preterm infants at term age needs further investigation.
Highlights
Modern neonatology has achieved high survival rates in neonatal intensive care units, allowing clinicians to focus on optimizing infant nutrition and growth
138 articles were included in this review, of which 110 articles presented body composition data measured with air displacement plethysmography (ADP)
Our results show that at 40 weeks postmenstrual age (PMA), preterm infants had a higher percent and absolute fat mass, but lower fat-free mass compared to term infants
Summary
Modern neonatology has achieved high survival rates in neonatal intensive care units, allowing clinicians to focus on optimizing infant nutrition and growth. A wide range of discharge weights have been reported in very preterm infants at different hospitals [1,2]. That at term-corrected age, preterm infants could have reached weights that match their term-born counterparts. The quality of weight gain in These infants remains unclear. Too little is known about the relative contributions of fat mass and fat-free mass and this needs to be explored further [3,4,5]. There is an emerging body of evidence to suggest that fat mass and fat-free mass are related to long-term outcomes. Ramel et al showed that in-hospital fat-free mass gain is associated with better neurological and motor outcomes at one year corrected age in very low birthweight infants [6], Nutrients 2020, 12, 288; doi:10.3390/nu12020288 www.mdpi.com/journal/nutrients
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