The association between BMI trajectories and bronchopulmonary dysplasia among very preterm infants

Ng, Laura Li Ching; Patel, Sharina; Plourde, Hugues; Besner, Marie-Eve; Lapointe, Anie; Bizgu, Victoria; Sant’Anna, Guilherme M.; Beltempo, Marc

doi:10.1038/s41390-022-02358-4

Cited by 8 publications

(6 citation statements)

References 51 publications

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“…This paper is the first prospective study that focused on the association between altered body proportionality and the severity of respiratory status. A recent study looked into whether changes in the BMI of preterm infants from birth to 36 weeks of post-menstrual age are associated with the likelihood of developing BPD [19]. The study found that increases in the BMI z-score from birth to 36 weeks PMA were linked to higher odds of BPD and an increase in its severity.…”

Section: Discussionmentioning

confidence: 99%

Association between Weight for Length and the Severity of Respiratory Morbidity in Preterm Infants

Alur,

Harvey,

Hart

et al. 2024

Children

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Association Between Weight for Length and the Severity of Respiratory Morbidity in Preterm Infants. Objective: To determine whether higher weight-to-length z-scores after 32 weeks of gestation are associated with higher pulmonary scores (PSs) in preterm infants requiring respiratory support using a prospective observational study. Methods: Infants born at <30 weeks, with a post-menstrual age (PMA) of 30–33 weeks, were enrolled. The infant’s weight, length, and head circumference were measured weekly. Data on calories/kg/d, protein g/kg/d, weight-for-length percentiles, z-scores, and BMI at 33 through 40 weeks PMA were collected. The PS was calculated. Results: We analyzed 91 infants. The mean gestational age was 26.9 ± 1.7 weeks. The mean birthweight was 0.898 ± 0.238 kgs. They were predominantly African American (81.3%) and girls (56%). Postnatal steroids were administered in 26.4% of the infants. The mean duration of invasive ventilation was 19.23 days ± 28.30 days. There was a significant association between the PS and W/L z-score (p < 0.0001). For every one-unit increase in W/L z-score, the PS increased by 0.063. There was a significant association between the PS and W/L percentile (p = 0.0017), as well as BMI (p ≤ 0.0001). For every unit increase in W/L percentile, the PS increased by 0.002, and for a unit increase in BMI, the PS increased by 0.04. The association remained significant after postnatal steroid use, sex, and corrected and birth gestational ages were included in the regression analysis. Nutrition did not affect the anthropometric measurements. Conclusions: Our study is the first to demonstrate that a higher BMI and W/L may adversely affect the respiratory severity in preterm infants. Studies with larger sample sizes are needed to confirm our findings.

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Section: Discussionmentioning

confidence: 99%

Association between Weight for Length and the Severity of Respiratory Morbidity in Preterm Infants

Alur,

Harvey,

Hart

et al. 2024

Children

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“…It is possible that Grade 3 BPD represents a distinct phenotype of the disease (20,21) with a slightly different pathophysiology, chronicity, and symptom trajectory, leading to a different impact on weight gain and brain development compared to milder forms of the disease. It is also possible that weight gain may have been disproportionate to linear gain and resulted in excess fat mass in these infants, a phenomenon that has been linked to increased risk of developing BPD, abnormal brain growth, and adverse neurodevelopment in preterm and low birth weight infants (22)(23)(24)(25). While we were unable to evaluate for this given the lack of available length measurements, the higher proportion of G/J tubes in infants with grade 3 BPD may have allowed for excess weight and body mass index gains.…”

Section: Discussionmentioning

confidence: 99%

“…There was considerable loss to follow up at 2 years, though the infants followed did not differ in substantive ways from those without follow-up data. And, though there is growing evidence that length and lean mass characterize clinically important aspects of growth trajectories (22,23) our data sources lacked this information. Despite these limitations, our study has several strengths.…”

Section: Discussionmentioning

confidence: 99%

Does Faster Weight Trajectory Lead to Improved Neurodevelopmental Outcomes in ELBW Infants with Bronchopulmonary Dysplasia?

Carter

Edwards

Jerome

et al. 2023

Preprint

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Objective: To examine the relationship between weight trajectory and 2-year neurodevelopmental outcomes for extremely low birthweight (ELBW) infants with BPD. Study Design:Secondary analysis of infants born from 2010 to 2019. The predictor was BPD severity and the outcome was neurodevelopmental impairment, defined as any Bayley Scales of Infant Development (BSID) III score <70 at 24 months’ corrected age. Repeated measures logistic regression was performed. Results: There were 5,042 infants included. Faster weight trajectory was significantly associated with a decreased probability of having at least one BSID III score <70 for infants with grade 1-2 BPD (p<0.0001) and an increased probability of having at least one BSID III score <70 for infants with grade 3 BPD (p<0.009). There was no significant association between weight trajectory and BSID III score <70 for infants with grade 0 BPD. Conclusion: The association between postnatal weight trajectory and neurodevelopmental outcome differs by BPD severity.

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“…For individual infants, accurate measurements can be achieved with proper equipment, timing, and standardized procedures conducted by two trained individuals. Emerging data that show an association between length and BMI growth on later neurodevelopment in preterm infants 9,[12][13][14][19][20][21] emphasize the need for careful length measurements and inclusion of BMI in the comprehensive growth assessment of preterm infants.…”

Section: Discussionmentioning

confidence: 99%

“…Body mass index (BMI, weight/height 2 ) is an important health outcome in children and adults since it is associated with body fat and associated health risks. 16 17 18 Evidence of the potential negative impact of disproportionate growth on health outcomes in preterm infants 9 14 19 20 21 has raised interest in this age group; however, debate continues over the ideal body proportionality measure. An early study 22 tested the utility of using a measure of weight for age versus weight for length (defined as weight/length 3 or ponderal index, in this study as it was the only measure of body proportionality with reference data available for preterm infants at the time of the study) in the growth assessment of preterm infants.…”

mentioning

confidence: 99%

Defining Body Mass Index Using Weight and Length for Gestational Age in the Growth Assessment of Preterm Infants at Birth

Olsen,

Granger,

Masoud

et al. 2023

Am J Perinatol

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Objective The objectives of this study were to describe (1) body mass indexes (BMIs) using weight and length for gestational age (GA) classifications, and (2) the additional information BMI, as a measure of body proportionality, provides for preterm infant growth assessment and care plans at birth. Study Design Birth weight, length, and BMI of 188,646 preterm infants (24–36 weeks gestation) admitted to U.S. neonatal intensive care units (Pediatrix Clinical Data Warehouse, 2013–2018) were classified (Olsen curves) as small, appropriate, or large for GA (SGA < 10th, AGA 10–90th, LGA > 90th percentile for GA, respectively). The distribution for the 27 weight–length–BMI combinations was described. Results At birth, most infants were appropriate for weight (80.0%), length (82.2%), head circumference (82.9%), and BMI (79.9%) for GA. Birth weight for GA identified approximately 20% of infants as SGA or LGA. Infants born SGA (or LGA) for both weight and length (“proportionate” in size) were usually appropriate for BMI (59.0% and 75.6%). BMI distinguished disproportionate weight for length in infants with SGA or LGA weight at birth (58.3%, 49.9%). BMI also identified 11.4% of AGA weight infants as small or large for BMI (“disproportionate” in size) at birth; only using weight for GA missed these underweight/overweight for length infants. Conclusion The unique, additional information provided by birth BMI further informs individualized preterm infant growth assessment by providing an assessment of an infant's body proportionality (weight relative to its length) in addition to the routine assessment of weight, length, and head circumference for GA and may better inform care plans and impact outcomes. Key Points

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The association between BMI trajectories and bronchopulmonary dysplasia among very preterm infants

Cited by 8 publications

References 51 publications

Association between Weight for Length and the Severity of Respiratory Morbidity in Preterm Infants

Association between Weight for Length and the Severity of Respiratory Morbidity in Preterm Infants

Does Faster Weight Trajectory Lead to Improved Neurodevelopmental Outcomes in ELBW Infants with Bronchopulmonary Dysplasia?

Defining Body Mass Index Using Weight and Length for Gestational Age in the Growth Assessment of Preterm Infants at Birth

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