*O-31: Growth and Fat Mass, But Not Fat-free Mass, are Compromised in Infants with Parenteral Nutrition Need after Neonatal Intestinal Surgery

Abstract

Introduction: Children with intestinal failure (IF) receiving long-term home parenteral nutrition (PN) have an altered body composition (BC), but early data on BC changes from the start of PN onwards are lacking. We aimed to assess growth and BC in infants after neonatal intestinal surgery necessitating PN, and to explore associations with clinical parameters. Methods: In this prospective cohort study, infants were included after intestinal surgery. IF was defined as PN-dependency for >60 days. Standard deviation scores (SDS) for anthropometric parameters were calculated until 6 months corrected age (ca). In a subgroup, fat mass (FM) and fat-free mass (FFM) were measured with air-displacement plethysmography (ADP) at 2 and 6 months ca. SDS for FM index (=FM in kg / (length in m)2) and FFM index were calculated. The association between the cumulative amount of PN (PNcum=area-under-the-curve of duration x energy percentage from PN) and anthropometric and BC parameters was evaluated with linear regression analyses correcting for sex and gestational age. Results: Ninety neonates were included (53% boys, 67% preterm, median birth weight -0.1 SDS, 40% with IF). Studied infants had compromised anthropometric parameters during follow-up. At 6 months ca, infants remained smaller (median weight-for-age SDS -0.9, p<0.001) and shorter (median length-for-age SDS -0.4, p=0.003) than the normal population. In 56 infants, 90 ADP measurements were performed. FM index SDS was significantly lower than the reference population at both 2 and 6 months ca (-0.8, p<0.001 and -0.7, p=0.001), but the FFM index SDS did not differ. PNcum was not associated with anthropometric or BC parameters. Conclusions: In this cohort of infants with PN need after neonatal surgery, compromised growth, decreased FM and adequate FFM were observed during the first 6 months. The cumulative amount of PN was not a predictor of BC outcomes. The need for continuing growth monitoring after 6 months of age seems obvious, but further research needs to explore the benefit of incorporating ongoing monitoring of BC during follow-up.