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. 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 SCVMC Research

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 Abdominal Fat Too little lean body mass 2010 NICHD 79 % of VLBW weigh < 10 th 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. 3.5 weeks and 5lb 7oz vs. 12 months and 17lb 13oz By Spencer Lacy Growth and Neurological Outcomes

14. The Course of Postnatal Growth in VLBW Infants predicts neurological outcomes better than the weight for age at birth Beatrice Latal-Hajnal et al J Pediatr2003:143:163-70 Birth 9 months 2 years 10%ile AGA SGA MDI 101.7 PDI 101.8 MDI 94.9 PDI 89.9 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 Data Growth Velocity with outcomes 18 -22 months Ehrenkranz et al Pediatrics 2006;117;1253 NICHD network 1994-1995 600 babies Children Less than 1000 gm 1st Quartile 2 nd Quartile3 rd Quartile4th Quartile Weight gain gm/kg/day 1215.617.821.2 MDI 75.777.779.780.9 PDI < 70 % 35321814 Normal Neuro Exam 70777686 Neurodevelopment al Impairment % 55494129

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

18. 500 children 1974 to 79 rainbow babies VLBW

19. Normal Head Subnormal head < 2 SD Intelligence Verbal IQ 9784.1 Performance IQ95.982.1 Academic Achievement a.Reading 93.777.2 b. Math94.386.1 c. Spelling90.678.6 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 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

24. CARING FOR THE FAMILY You can make a difference !