Background: Poor postnatal weight gain in very low birth weight (VLBW) preterm infants has been shown to have a negative effect on neurodevelopment. However, the dose-dependent neurodevelopmental consequences of linear stunting in this population have not previously been assessed. Understanding this relationship is important because organ growth and differentiation are more tightly linked to lean body mass and thus linear growth. Objective: To assess the duration and clinical determinants of poor linear growth and its relationship to neurodevelopment in preterm infants. Methods: Weight, recumbent length and head circumference were recorded at birth, hospital discharge, and at 4, 12 and 24 months corrected age (CA) in 62 VLBW infants. Standardized Z-scores for weight (WZ), length (LZ) and head circumference (HCZ) were calculated and assessed as a function of inpatient clinical factors using linear regression models. Twenty-four-month neurodevelopmental function was analyzed as a function of growth status. Results: Mean LZ was lower than WZ (p = 0.004) at hospital discharge, was related in part to illness severity and remained lower than baseline LZ until 24 months CA. Controlling for WZ and HCZ at each age, lower LZ at 4 and 12 months CA was associated with lower cognitive function scores at 24 months CA (p ≤ 0.03). Conclusions: Nutritional and nonnutritional factors influenced the degree of pre- and postdischarge linear growth suppression in VLBW infants, which in turn was negatively associated with developmental outcomes at 24 months CA. Since linear growth correlates with brain growth and indexes a number of clinical factors, it is an important biomarker that can be used in VLBW infants to predict long-term developmental outcomes.

Optimizing nutrition during foetal and early postnatal life is a golden opportunity to impact neurodevelopment and brain function across the lifespan.

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Markedly lower FFM and higher adiposity were observed in preterm infants at term CA, but these differences had lessened and were no longer statistically significant at 3 to 4 months CA. Although early nutrition was associated with growth trajectories in the hospital, the continuing influence of early illness on postdischarge growth suggests that nonnutritional factors (eg, disturbances in the growth hormone axis) also may affect body composition trajectories of preterm infants.

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The brain is the most highly metabolic organ in the preterm neonate and consumes the greatest amount of nutrient resources for its function and growth. As preterm infants survive at greater rates, neurodevelopment has become the primary morbidity outcome of interest. While many factors influence neurodevelopmental outcomes in preterm infants, nutrition is of particular importance because the healthcare team has a great deal of control over its provision. Studies over the past 30 years have emphasized the negative neurodevelopmental consequences of poor nutrition and growth in the preterm infant. While all nutrients are important for brain development, certain ones including glucose, protein, fats (including long-chain polyunsaturated fatty acids), iron, zinc, copper, iodine, folate and choline have particularly large roles in the preterm infant. They affect major brain processes such as neurogenesis, neuronal differentiation, myelination and synaptogenesis, all of which are proceeding at a rapid pace between 22 and 42 weeks' post-conception. At the macronutrient level, weight gain, linear growth (independent of weight gain) and head circumference growth are markers of nutritional status. Each has been associated with long-term neurodevelopment. The relationship of micronutrients to neurodevelopment in preterm infants is understudied in spite of the large effect these nutrients have in other young populations. Nutrients do not function alone to stimulate brain development, but rather in concert with growth factors, which in turn are dependent on adequate nutrient status (e.g. protein, zinc) as well as on physiologic status. Non-nutritional factors such as infection, corticosteroids, and inflammation alter how nutrients are accreted and distributed, and also suppress growth factor synthesis. Thus, nutritional strategies to optimize brain growth and development include assessment of status at birth, aggressive provision of nutrients that are critical in this time period, control of non-nutritional factors that impede brain growth and repletion of nutrient deficits.

Background Air-displacement plethysmography (ADP) is a good candidate for monitoring body composition in newborns and young infants, but reference centile curves are lacking that allow for assessment at birth and across the first 6 mo of life. Objective Using pooled data from 4 studies, we aimed to produce new charts for assessment according to gestational age at birth (30 + 1 to 41 + 6 wk) and postnatal age at measurement (1–27 wk). Methods The sample comprised 222 preterm infants born in the United States who were measured at birth; 1029 term infants born in Ireland who were measured at birth; and 149 term infants born in the United States and 57 term infants born in Italy who were measured at birth, 1 and 2 wk, and 1, 2, 3, 4, 5, and 6 mo of age. Infants whose birth weights were <3rd or >97th centile of the INTERGROWTH-21st standard were excluded, thereby ensuring that the charts depict body composition of infants whose birth weights did not indicate suboptimal fetal growth. Sex-specific centiles for fat mass (kg), fat-free mass (kg), and percentage body fat were estimated using the lambda-mu-sigma (LMS) method. Results For each sex and measure (e.g., fat mass), the new charts comprised 2 panels. The first showed centiles according to gestational age, allowing term infants to be assessed at birth and preterm infants to be monitored until they reached term. The second showed centiles according to postnatal age, allowing all infants to be monitored to age 27 wk. The LMS values underlying the charts were presented, enabling researchers and clinicians to convert measurements to centiles and z scores. Conclusions The new charts provide a single tool for the assessment of body composition, according to ADP, in infants across the first 6 mo of life and will help enhance early-life nutritional management.

In VPT infants, early FFM gains are associated with faster SOP, whereas post-discharge FM gains are associated with higher BPs at 4 yrs. This shows birth to 4 mos CGA is a sensitive period for growth and its relation to neurodevelopmental and metabolic outcomes. Close monitoring and early nutritional adjustments to optimize quality of gains may improve outcomes.