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Is the Infants BMI important ?. Sonya Misra MBBS MPH Oct 17 2014. Disclosures. Nothing to Disclose except I think growth is very important. Objectives. Define BMI components and Growth Charts Discuss the differences between growth pattern of Preterm Infants and Term babies - PowerPoint PPT Presentation
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IS THE INFANTS BMI IMPORTANT ?Sonya Misra MBBS MPH
Oct 17 2014
Disclosures• Nothing to Disclose
• except
• I think growth is very important.
Objectives • Define BMI components and Growth Charts• Discuss the differences between growth pattern of
Preterm Infants and Term babies• Discuss some of the evidence demonstrating importance
of growth on Neurodevelopmental Outcomes
What is mothers first question ?
BMI• Formula : weight (kg) / [height (m)]2 • BMI is a fairly reliable screening indicator of body fatness
for most adults.• BMI does not measure body fat directly, but research has
shown that BMI correlates to direct measures of body fat, such as underwater weighing and dual energy x-ray absorptiometry (DXA).
Air Displacement Plethysmography
vMeasure of Adiposity and Lean body mass
Gestation TermBody Weight 3.3 kgOFC 34 cmLength 50 cmFat Free mass normalBody fatness 10 %
Gestation 26 weeks now termBody Weight 2.5 kgOFC 33 cmLength 46 cmFat free mass lowBody fatness 20 %
So far our Primis have been showing a lack of lean body mass and more abdominal fat
1. Term Infants of Diabetic mothers have a higher body fat percent compared to infants of mother without diabetes 2. This increase of body fat is also seen in a cohort of babies from 30 to 36 weeks
At SCVMCResearch
Gestation TermBody Weight 5 kgOFC 33 cmLength 50 cmBody fatness 25 %
Gestation 26 weeks now termBody Weight 2.5 kgOFC 33 cmLength 46 cmBody fatness 20 %
So far our Primis show a lack of lean body mass and more abdominal fat
Disproportionate growth reduced length
reduced fat free mass
Abdominal Fat
Too little lean body mass
2010 NICHD 79 % of VLBW weigh < 10th at 36 weeks
Abdominal fat in Adults• Linked to lower muscle mass• Possibly due to lower estrogen• Visceral fat has been linked to
• Cardiovascular disease • Type 2 diabetes• Colorectal Cancer
• Low Physical Activity and High calorie diets
3.5 weeks and 5lb 7oz vs. 12 months and 17lb 13oz
By Spencer Lacy
Growth and Neurological Outcomes
The Course of Postnatal Growth in VLBW Infants predicts neurological outcomes better than the weight for age at birthBeatrice Latal-Hajnal et al J Pediatr2003:143:163-70
Birth 9 months 2 years
10%ile
AGA
SGA
MDI 101.7PDI 101.8
MDI 94.9PDI 89.9
Length of SGA stayed SGA had 10 point lower MDI than those that recovered.OFC did not predict outcomes
Weight Gain• Many different studies • Franz 2008 Correlation between weight at discharge and
outcomes at 5 years of age• Children with Catch up growth also less problems• Better Growth to discharge associated with better
motor development and cognitive development
American DataGrowth Velocity with outcomes 18 -22 monthsEhrenkranz et al Pediatrics 2006;117;1253
NICHD network 1994-1995 600 babiesChildren Less than 1000 gm
1st Quartile
2nd Quartile 3rd Quartile 4th Quartile
Weight gain gm/kg/day
12 15.6 17.8 21.2
MDI 75.7 77.7 79.7 80.9PDI < 70 % 35 32 18 14Normal Neuro Exam
70 77 76 86
Neurodevelopmental Impairment %
55 49 41 29
3.5 weeks and 5lb 7oz vs. 12 months and 17lb 13oz
By Spencer Lacy
Growth
500 children 1974 to 79 rainbow babies VLBW
Normal Head
Subnormal head < 2 SD
IntelligenceVerbal IQ
97 84.1
Performance IQ 95.9 82.1
Academic Achievementa. Reading
93.7 77.2
b. Math 94.3 86.1
c. Spelling 90.6 78.6
8 year old outcomes based on HC at 8 Months Hack et al continued
Failure of Length or linear growth and Outcomes
• Lean Body mass• Hardest hit of all the measurements• Most nutritional strategies have failed to help• Non nutritional factors ?
• Stress hormones ? • Inflammation
Same Factors responsible for both Shorter Lengths and Poor outcomes• Nutritional -
• Protein 4.2 -4.8 g/kg/day normal neurogenesis dendritic arborization synaptogenesis and myelin production
• Carbohydrates • Fat • Zn
• Inflammatory chronic - IL6 and TNF alpha • Affect neurons and white matter• Suppressing GH/IGF-1 axes
Summary• Good Growth cannot be considered to be weight gain
alone• Changes in HC or Length are also associated with long
term neurodevelopmental changes• Best outcomes in better grown babies• Important to monitor closely with growth charts and body
composition• Enhance Fat Free Mass by
Minimize inflammation
Adequate Protein Intake
Exercise
Massage ?
Pro Growth Interventions New Directions
• OLD Make sure you have enough calories and protein and micronutrients
• Massage – several studies have shown up to a 20 % increase in weight gain.
• Reduce inflammation. Work on ways to decrease CLABSI• Breast milk feeding better bacteria ?• Increase parasympathetic tone
• Decrease pain • Reduce anxiety/stress – Skin to skin• Frequent family visits
CARING FOR THE FAMILYYou can make a difference !