Background: The identification of factors involved in the postnatal growth of preterm infants will help achieve growth similar to that of term infants. Objectives: As per protocol: to compare body composition in very preterm infants at term-corrected age (TCA) with that in term infants, and to explore relationships between neonatal characteristics and body composition in preterm infants. Methods: Anthropometry, nutritional characteristics, and neonatal outcomes were prospectively collected in 26 preterm (<29 weeks) and 33 term (37-40 weeks) infants. Body composition using dual-energy X-ray absorptiometry (DXA) was measured at TCA in preterm infants and between days 7 and 10 in term infants. Results: Parenteral nutrition in preterm infants provided a mean of 2.9 ± 0.2 and 2.1 ± 0.5 g/kg/day of intravenous amino acids and lipids, respectively, during the first week of life. The mean weight gain velocity from birth to DXA assessment was 12.1 ± 1.4 g/kg/day. Compared with term infants, preterm infants at TCA were shorter and lighter, with a smaller head circumference, a lower weight estimated by DXA (2,960 ± 552 vs. 3,843 ± 377 g), and increased skinfold thicknesses. Fat mass percent (13.9 ± 5.4%) and lean mass percent (84.7 ± 5.6%) in preterm infants were similar to those in term infants (14.7 ± 3.5 and 83.5 ± 3.6%, respectively). Neonatal weight gain velocity in preterm infants was positively associated with lean mass (grams). Conclusion: Subcutaneous fat is increased in preterm infants. Higher protein intake in preterm infants might increase weight gain velocity and achieve a lean mass comparable to that of term infants.

Exercise intensity modulates neonatal body composition. The long-term significance of a reduced BW, adiposity and BMC with VPA requires further study.

ABSTRACT.Objective. This randomized, controlled trial was designed to determine the efficacy of inhaled fluticasone propionate on oxygen therapy weaning in a population of preterm infants who were born at <32 weeks of gestation and experienced moderate bronchopulmonary dysplasia (BPD).Methods. Thirty-two infants who were <32 weeks of gestation, had moderate BPD that required supplemental oxygen (fraction of inspired oxygen >0.25), and were aged between 28 and 60 days were randomized. Fluticasone propionate 125 g twice daily for 3 weeks and once daily for a fourth week was delivered to infants who weighed between 500 and 1200 g. The dosage was doubled for infants who weighed >1200 g.Results. Compared with placebo, treatment had no effect on either duration of supplemental O 2 therapy or ventilatory support as assessed by survival analysis. At 28 days, a trend toward a lower cortisol/creatinine ratio in the treatment group was noted compared with placebo (25.1 ؎ 18.9 vs 43 ؎ 14.4). In the fluticasone group at 28 days, the systolic arterial pressure (78 ؎ 3 vs 68 ؎ 3 mm Hg) and diastolic arterial pressure (43 ؎ 3.4 mm Hg vs 38 ؎ 2.0 mm Hg) were higher compared with baseline fluticasone values. The chest radiograph score was lower than baseline (2.8 ؎ 1.4 vs 3.7 ؎ 2.2) in the fluticasone group at 28 days. This study has a statistical power of 1.0 to detect a significant difference in the duration of oxygen supplementation of >21 days between the study groups.Conclusion. We conclude that fluticasone propionate reduces neither supplemental O 2 use nor the need for ventilatory support in this patient population. However, fluticasone does have a positive radiologic effect in lowering chest radiograph scores. In addition, our data point to a possible association among inhaled fluticasone treatment and higher arterial blood pressure. ABBREVIATIONS. BPD, bronchopulmonary dysplasia; Fio 2 , fraction of inspired oxygen. B ronchopulmonary dysplasia (BPD) is an important sequela in the successful treatment of premature infants; BPD can occur without initial respiratory distress syndrome. 1 The development of BPD is strongly associated with respiratory distress syndrome, prematurity, low birth weight, male gender, and the presence of patent ductus arteriosus. 2 The pathophysiology of BPD is multifactorial; therefore, the treatment is multipronged. 3 At least 4 different mechanisms can explain abnormalities found in infants with BPD: (1) pulmonary edema, (2) bronchoconstriction and airway hyperactivity, (3) airway inflammation, and (4) chronic lung injury and repair. Inflammation is thought to be an important factor in the development of BPD. 4 Mechanical ventilation, oxygen use, and infection (either prenatally or postnatally acquired) are associated with an increase in the proinflammatory response of the immature lung. 5 Proinflammatory cytokines are present in the air spaces of ventilated preterm infants and in higher concentration in infants who subsequently develop BPD. 6 This inflammatory response, although possibly benefi...

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