Download PDF
Am J Perinatol
DOI: 10.1055/s-0043-1774316
Original Article

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

Irene E. Olsen
1   Department of Nutrition Sciences, College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania
,
Marion Granger
2   School of Data Science and Analytics, Kennesaw State University, Kennesaw, Georgia
,
Waleed Masoud
2   School of Data Science and Analytics, Kennesaw State University, Kennesaw, Georgia
,
Reese H. Clark
3   The Pediatrix Center for Research, Education, Quality, and Safety (CREQS), Pediatrix Medical Group, Inc., Sunrise, Florida
,
A. Nicole Ferguson 
2   School of Data Science and Analytics, Kennesaw State University, Kennesaw, Georgia
› Author Affiliations Funding This work was partially funded by The Gerber Foundation (grant no.: 7247).
› Further Information
   Buy Article Permissions and Reprints

Abstract

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

  • Most preterm infants were born AGA for all growth measures.

  • AGA weight infants may be under- or overweight for length.

  • BMI distinguished body disproportionality in SGA/LGA infants.

  • Recommend BMI assessed along with weight, length and head.

  • Further research on BMI in preterm infants is needed.

Keywords

body mass index - preterm infants - body disproportionality - disproportionate - symmetric - asymmetric - weight for length ratio - small for gestational age - large for gestational age

Note

The Gerber Foundation partially funded the work, but did not have involvement in the study design, data collection, analysis, and interpretation of data, writing of the report, or decision to submit the paper for publication.




Publication History

Received: 17 May 2023

Accepted: 07 August 2023

Article published online:
08 September 2023

© 2023. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Battaglia FC, Lubchenco LO. A practical classification of newborn infants by weight and gestational age. J Pediatr 1967; 71 (02) 159-163
    CrossrefPubMedGoogle Scholar
  • 2 Boghossian NS, Geraci M, Edwards EM, Horbar JD. Morbidity and mortality in small for gestational age infants at 22 to 29 weeks' gestation. Pediatrics 2018; 141 (02) e20172533
    CrossrefPubMedGoogle Scholar
  • 3 De Jesus LC, Pappas A, Shankaran S. et al; Eunice Kennedy Shriver National Institute of Health and Human Development Neonatal Research Network. Outcomes of small for gestational age infants born at <27 weeks' gestation. J Pediatr 2013; 163 (01) 55-60.e1-e3
    CrossrefPubMedGoogle Scholar
  • 4 Huang K, Si S, Chen R. et al. Preterm birth and birth weight and the risk of type 1 diabetes in Chinese children. Front Endocrinol (Lausanne) 2021; 12: 603277
    CrossrefPubMedGoogle Scholar
  • 5 Katz J, Lee AC, Kozuki N. et al; CHERG Small-for-Gestational-Age-Preterm Birth Working Group. Mortality risk in preterm and small-for-gestational-age infants in low-income and middle-income countries: a pooled country analysis. Lancet 2013; 382 (9890) 417-425
    CrossrefPubMedGoogle Scholar
  • 6 Boghossian NS, Geraci M, Edwards EM, Horbar JD. In-hospital outcomes in large for gestational age infants at 22-29 weeks of gestation. J Pediatr 2018; 198: 174-180.e13
    CrossrefPubMedGoogle Scholar
  • 7 Clark RH, Olsen IE, Spitzer AR. Assessment of neonatal growth in prematurely born infants. Clin Perinatol 2014; 41 (02) 295-307
    CrossrefPubMedGoogle Scholar
  • 8 Ehrenkranz RA, Dusick AM, Vohr BR, Wright LL, Wrage LA, Poole WK. Growth in the neonatal intensive care unit influences neurodevelopmental and growth outcomes of extremely low birth weight infants. Pediatrics 2006; 117 (04) 1253-1261
    CrossrefPubMedGoogle Scholar
  • 9 Kerkhof GF, Willemsen RH, Leunissen RW, Breukhoven PE, Hokken-Koelega AC. Health profile of young adults born preterm: negative effects of rapid weight gain in early life. J Clin Endocrinol Metab 2012; 97 (12) 4498-4506
    CrossrefPubMedGoogle Scholar
  • 10 Ong KK, Kennedy K, Castañeda-Gutiérrez E. et al. Postnatal growth in preterm infants and later health outcomes: a systematic review. Acta Paediatr 2015; 104 (10) 974-986
    CrossrefPubMedGoogle Scholar
  • 11 Raghuram K, Yang J, Church PT. et al; Canadian Neonatal Network, Canadian Neonatal Follow-Up Network Investigators. Head growth trajectory and neurodevelopmental outcomes in preterm neonates. Pediatrics 2017; 140 (01) e20170216
    CrossrefPubMedGoogle Scholar
  • 12 Ramel SE, Demerath EW, Gray HL, Younge N, Boys C, Georgieff MK. The relationship of poor linear growth velocity with neonatal illness and two-year neurodevelopment in preterm infants. Neonatology 2012; 102 (01) 19-24
    CrossrefPubMedGoogle Scholar
  • 13 Simon L, Théveniaut C, Flamant C, Frondas-Chauty A, Darmaun D, Rozé JC. In preterm infants, length growth below expected growth during hospital stay predicts poor neurodevelopment at 2 years. Neonatology 2018; 114 (02) 135-141
    CrossrefPubMedGoogle Scholar
  • 14 Meyers JM, Tan S, Bell EF. et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Neurodevelopmental outcomes among extremely premature infants with linear growth restriction. J Perinatol 2019; 39 (02) 193-202
    CrossrefPubMedGoogle Scholar
  • 15 American Academy of Pediatrics Committee on Nutrition. Assessment of nutritional status. In: Kleinman RE, Greer FR, eds. Pediatric Nutrition. 8th ed. Itasca, IL: American Academy of Pediatrics; 2019: 723-73
    Google Scholar
  • 16 Ellis KJ. Selected body composition methods can be used in field studies. J Nutr 2001; 131 (05) 1589S-1595S
    CrossrefPubMedGoogle Scholar
  • 17 Gallagher D, Visser M, Sepúlveda D, Pierson RN, Harris T, Heymsfield SB. How useful is body mass index for comparison of body fatness across age, sex, and ethnic groups?. Am J Epidemiol 1996; 143 (03) 228-239
    CrossrefPubMedGoogle Scholar
  • 18 Park MH, Falconer C, Viner RM, Kinra S. The impact of childhood obesity on morbidity and mortality in adulthood: a systematic review. Obes Rev 2012; 13 (11) 985-1000
    CrossrefPubMedGoogle Scholar
  • 19 Belfort MB, Gillman MW, Buka SL, Casey PH, McCormick MC. Preterm infant linear growth and adiposity gain: trade-offs for later weight status and intelligence quotient. J Pediatr 2013; 163 (06) 1564-1569.e2
    CrossrefPubMedGoogle Scholar
  • 20 Belfort MB, Rifas-Shiman SL, Sullivan T. et al. Infant growth before and after term: effects on neurodevelopment in preterm infants. Pediatrics 2011; 128 (04) e899-e906
    CrossrefPubMedGoogle Scholar
  • 21 Li Ching Ng L, Patel S, Plourde H. et al. The association between BMI trajectories and bronchopulmonary dysplasia among very preterm infants. Pediatr Res 2023; 93 (06) 1609-1615
    CrossrefPubMedGoogle Scholar
  • 22 Olsen IE, Lawson ML, Meinzen-Derr J. et al. Use of a body proportionality index for growth assessment of preterm infants. J Pediatr 2009; 154 (04) 486-491
    CrossrefPubMedGoogle Scholar
  • 23 Benn RT. Some mathematical properties of weight-for-height indices used as measures of adiposity. Br J Prev Soc Med 1971; 25 (01) 42-50
    PubMedGoogle Scholar
  • 24 Cole TJ, Green PJ. Smoothing reference centile curves: the LMS method and penalized likelihood. Stat Med 1992; 11 (10) 1305-1319
    CrossrefPubMedGoogle Scholar
  • 25 Ferguson AN, Grabich SC, Olsen IE. et al. BMI is a better body proportionality measure than the ponderal index and weight-for-length for preterm infants. Neonatology 2018; 113 (02) 108-116
    CrossrefPubMedGoogle Scholar
  • 26 Olsen IE, Lawson ML, Ferguson AN. et al. BMI curves for preterm infants. Pediatrics 2015; 135 (03) e572-e581
    CrossrefPubMedGoogle Scholar
  • 27 Demerath EW, Johnson W, Davern BA. et al. New body composition reference charts for preterm infants. Am J Clin Nutr 2017; 105 (01) 70-77
    CrossrefPubMedGoogle Scholar
  • 28 Giannì ML, Roggero P, Liotto N. et al. Body composition in late preterm infants according to percentile at birth. Pediatr Res 2016; 79 (05) 710-715
    CrossrefPubMedGoogle Scholar
  • 29 Norris T, Ramel SE, Catalano P. et al. New charts for the assessment of body composition, according to air-displacement plethysmography, at birth and across the first 6 mo of life. Am J Clin Nutr 2019; 109 (05) 1353-1360
    CrossrefPubMedGoogle Scholar
  • 30 Ramel SE, Gray HL, Davern BA, Demerath EW. Body composition at birth in preterm infants between 30 and 36 weeks gestation. Pediatr Obes 2015; 10 (01) 45-51
    CrossrefPubMedGoogle Scholar
  • 31 Villar J, Puglia FA, Fenton TR. et al. Body composition at birth and its relationship with neonatal anthropometric ratios: the newborn body composition study of the INTERGROWTH-21st project. Pediatr Res 2017; 82 (02) 305-316
    CrossrefPubMedGoogle Scholar
  • 32 Koletzko B, Cheah F-C, Domellof M, van Goudoever JB, Poindexter BB, Vain N. Scientific basis and practical guidelines of nutritional care of preterm infants. World Rev Nutr Diet 2021; 122: XIII-XIV
    CrossrefPubMedGoogle Scholar
  • 33 Cordova EG, Belfort MB. Updates on assessment and monitoring of the postnatal growth of preterm infants. Neoreviews 2020; 21 (02) e98-e108
    CrossrefPubMedGoogle Scholar
  • 34 Griffin IJ. Growth management in preterm infants. Accessed August 18, 2023 at: UpToDate.com. 2021
    PubMedGoogle Scholar
  • 35 Olsen IE, Groveman SA, Lawson ML, Clark RH, Zemel BS. New intrauterine growth curves based on United States data. Pediatrics 2010; 125 (02) e214-e224
    CrossrefPubMedGoogle Scholar
  • 36 Nagel E, Desjardins C, Earthman C, Ramel S, Demerath E. Weight for length measures may not accurately reflect adiposity in preterm infants born appropriate for gestational age during hospitalisation or after discharge from the neonatal intensive care unit. Pediatr Obes 2021; 16 (05) e12744
    CrossrefPubMedGoogle Scholar
  • 37 Ramel SE, Zhang L, Misra S, Anderson CG, Demerath EW. Do anthropometric measures accurately reflect body composition in preterm infants?. Pediatr Obes 2017; 12 (Suppl. 01) 72-77
    CrossrefPubMedGoogle Scholar
  • 38 Ng DV, Brennan-Donnan J, Unger S. et al. How close are we to achieving energy and nutrient goals for very low birth weight infants in the first week?. JPEN J Parenter Enteral Nutr 2017; 41 (03) 500-506
    CrossrefPubMedGoogle Scholar
  • 39 Hamatschek C, Yousuf EI, Möllers LS. et al. Fat and fat-free mass of preterm and term infants from birth to six months: a review of current evidence. Nutrients 2020; 12 (02) 288
    CrossrefPubMedGoogle Scholar
  • 40 Barker DJ. The developmental origins of chronic adult disease. Acta Paediatr Suppl 2004; 93 (446) 26-33
    CrossrefPubMedGoogle Scholar
  • 41 Oken E, Gillman MW. Fetal origins of obesity. Obes Res 2003; 11 (04) 496-506
    CrossrefPubMedGoogle Scholar
  • 42 Griffin IJ, Cooke RJ. Development of whole body adiposity in preterm infants. Early Hum Dev 2012; 88 (Suppl. 01) S19-S24
    CrossrefPubMedGoogle Scholar
  • 43 Baty BJ, Blackburn BL, Carey JC. Natural history of trisomy 18 and trisomy 13: I. growth, physical assessment, medical histories, survival, and recurrence risk. Am J Med Genet 1994; 49 (02) 175-188
    CrossrefPubMedGoogle Scholar
  • 44 Cereda A, Carey JC. The trisomy 18 syndrome. Orphanet J Rare Dis 2012; 7: 81
    CrossrefPubMedGoogle Scholar
  • 45 MedlinePlus. Beckwith-Wiedemann syndrome. Bethesda (MD): National Library of Medicine (US). [updated December 3 2021]. Accessed November 14, 2022 at: https://medlineplus.gov/genetics/condition/beckwith-wiedemann-syndrome/
    PubMedGoogle Scholar
  • 46 Manapurath R, Gadapani B, Pereira-da-Silva L. Body composition of infants born with intrauterine growth restriction: a systematic review and meta-analysis. Nutrients 2022; 14 (05) 1085
    CrossrefPubMedGoogle Scholar
  • 47 Wood AJ, Raynes-Greenow CH, Carberry AE, Jeffery HE. Neonatal length inaccuracies in clinical practice and related percentile discrepancies detected by a simple length-board. J Paediatr Child Health 2013; 49 (03) 199-203
    CrossrefPubMedGoogle Scholar