Abstract
A practical approach for nutritional assessment in preterm infants under intensive care, based on anthropometric measurements and commonly used biochemical markers, is suggested. The choice of anthropometric charts depends on the purpose: Fenton 2013 charts to assess intrauterine growth, an online growth calculator to monitor intra-hospital weight gain, and Intergrowth-21st standards to monitor growth after discharge. Body weight, though largely used, does not inform on body compartment sizes. Mid-upper arm circumference estimates body adiposity and is easy to measure. Body length reflects skeletal growth and fat-free mass, provided it is accurately measured. Head circumference indicates brain growth. Skinfolds estimate reasonably body fat. Weight-to-length ratio, body mass index, and ponderal index can assess body proportionality at birth. These and other derived indices, such as the mid-upper arm circumference to head circumference ratio, could be proxies of body composition but need validation. Low blood urea nitrogen may indicate insufficient protein intake. Prealbumin and retinol binding protein are good markers of current protein status, but they may be affected by non-nutritional factors. The combination of a high serum alkaline phosphatase level and a low serum phosphate level is the best biochemical marker for the early detection of metabolic bone disease.
Highlights
Growth faltering has been extensively documented in infants born very prematurely, being attributed to inadequate nutrient intake and lack of standardization in feeding practices [1,2].Poor postnatal growth is associated with adverse neurocognitive outcomes [3]
Fast postnatal growth is associated to better neurodevelopment in preterm infants, early fast weight gain may be associated with later obesity, high blood pressure, and adverse cardiovascular and metabolic outcomes [3,4,5]
Accurate anthropometry should rely on appropriate technique and instrumentation, and the obtained results interpreted by plotting on appropriate growth charts or comparing with appropriate reference values [11,16]
Summary
Medicine of Woman, Childhood and Adolescence, Faculdade de Ciências Médicas|NOVA Medical School, Unversidade Nova de Lisboa, 1169-056 Lisbon, Portugal. Dietetics and Nutrition, Lisbon Polytechnic Institute, Lisbon School of Health Technology, Av. NICU, Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, 1169-045 Lisbon, Portugal. Nuremberg General Hospital, Department of Pediatrics, Paracelsus Medical University, Prof.-Ernst-Nathan-Straße 1, 90419 Nürnberg, Germany
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