Early body composition changes are associated with neurodevelopmental and metabolic outcomes at 4 years of age in very preterm infants

BACKGROUND: Very preterm (VPT) infants are at risk for altered growth, slower speed of processing (SOP) and hypertension. This study assesses the relationship between postnatal body composition (BC), neurodevelopment (indexed by SOP) and blood pressure (BP) in VPT infants. METHODS: 34 VPT infants underwent weekly measurements and BC testing until discharge, and post-discharge at 4mos CGA and 4yrs. At post-discharge visits, SOP was assessed using visual evoked potentials and the NIH Toolbox; BP was also measured. RESULTS: In-hospital rate of weight, length and fat-free mass (FFM) gains were associated with faster SOP at 4yrs. Higher rate of gains in weight and FFM from discharge to 4mos CGA were associated with faster SOP at 4mos CGA, while higher fat mass (FM) gains during the same time were positively associated with BP at 4yrs. BC at 4yrs nor gains beyond 4mos CGA were associated with outcomes. CONCLUSIONS: In VPT infants, early FFM gains are associated with faster SOP, whereas post-discharge FM gains are associated with higher BPs at 4yrs. This shows birth to 4mos CGA is a sensitive period for growth and its relation to neurodevelopmental and metabolic outcomes. Close monitoring and early nutritional adjustments to optimize quality of gains may improve outcomes.