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Is the Infants BMI important ?

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

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Is the Infants BMI important ?

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  1. Is the Infants BMI important ? Sonya Misra MBBS MPH Oct 17 2014

  2. Disclosures • Nothing to Disclose • except • I think growth is very important.

  3. 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

  4. Wikipedia

  5. What is mothers first question ?

  6. 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).

  7. Air Displacement Plethysmography v Measure of Adiposity and Lean body mass

  8. Gestation Term Body Weight 3.3 kg OFC 34 cm Length 50 cm Fat Free mass normal Body fatness 10 % Gestation 26 weeks now term Body Weight 2.5 kg OFC 33 cm Length 46 cm Fat free mass low Body fatness 20 % So far our Primis have been showing a lack of lean body mass and more abdominal fat

  9. At SCVMC Research 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

  10. Gestation Term Body Weight 5 kg OFC 33 cm Length 50 cm Body fatness 25 % Gestation 26 weeks now term Body Weight 2.5 kg OFC 33 cm Length 46 cm Body fatness 20 % So far our Primis show a lack of lean body mass and more abdominal fat

  11. Disproportionate growth reduced length reduced fat free mass Too little lean body mass Abdominal Fat 2010 NICHD 79 % of VLBW weigh < 10th at 36 weeks

  12. 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

  13. Growth and Neurological Outcomes By Spencer Lacy 3.5 weeks and 5lb 7oz vs. 12 months and 17lb 13oz

  14. 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 MDI 101.7 PDI 101.8 AGA 10%ile MDI 94.9 PDI 89.9 SGA Birth 9 months 2 years Length of SGA stayed SGA had 10 point lower MDI than those that recovered. OFC did not predict outcomes

  15. 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

  16. American DataGrowth Velocity with outcomes 18 -22 monthsEhrenkranz et al Pediatrics 2006;117;1253 NICHD network 1994-1995 600 babies Children Less than 1000 gm

  17. Growth By Spencer Lacy 3.5 weeks and 5lb 7oz vs. 12 months and 17lb 13oz

  18. 500 children 1974 to 79 rainbow babies VLBW

  19. 8 year old outcomes based on HC at 8 Months Hack et al continued

  20. 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

  21. 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

  22. 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 ?

  23. Pro Growth InterventionsNew 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

  24. Caring for the family You can make a difference !

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