Biomedical subjects

M S Fewtrell

Publications and source records attributed to M S Fewtrell.

At least 19 recordsLinked to original sources

PubMed2006

Body composition in normal weight, overweight and obese children: matched case-control analyses of total and regional tissue masses, and body composition trends in relation to relative weight.

BACKGROUND: Childhood obesity is defined on the basis of weight and height, using body mass index (BMI). There is little detailed information on the body composition characteristic of overweight and obesity. OBJECTIVE: To evaluate total and regional body composition in overweight, obese and control children aged 7-14 years. DESIGN: Body composition was measured by the four-component model and dual X-ray absorptiometry in 38 age- and sex-matched pairs of obese and control children. Body composition trends were also evaluated by quintile of BMI standard deviation score (SDS) in these and 31 other children (n=107; BMI SDS range -1.0 to 4.3). RESULTS: Obese children were taller than controls (Delta=0.6 SDS; P=0.01) and had greater hydration of fat-free mass (FFM) (Delta=1.8 %, P<0.0001). After adjusting for these variables, obese children had greater FFM, fat mass (FM) and mineral (P<0.0001). Regional analyses showed that these differences were apparent in the arm, leg and trunk, but the three tissues had different proportional distributions of the excess. Fat was primarily in the trunk, but mineral in the leg. FM, FFM, hydration and mineral mass all increased across BMI SDS quintiles (P<0.0001), but the trend for FM was much the steepest. DISCUSSION: The greater weight of obese children is due to excess FFM including mineral as well as excess fatness. Increasing weight has a strong continuous relationship with increasing FM across the whole spectrum of weight.

Absorptiometry, Photon↗

PubMed2006

Bone mineralization in children with epidermolysis bullosa.

BACKGROUND: Various factors may have deleterious effects on bone health in patients with epidermolysis bullosa (EB). OBJECTIVES: In a retrospective notes review, to assess bone mineralization in children with EB and to identify the relative contributions of nutrition, activity and disease severity to low bone mass. METHODS: Thirty-nine children with EB [32 recessive dystrophic EB (RDEB), four Dowling-Meara EB simplex (DMEBS) and three junctional EB (JEB)] had lumbar spine bone mass measured using dual X-ray absorptiometry (GE Lunar Prodigy; GE Healthcare, Chalfont St Giles, U.K.). Seventy-six healthy children were also studied. Weight and height were recorded and mobility was rated. RESULTS: Children with RDEB and JEB, but not those with DMEBS, had lower bone mineral density SD scores than controls; differences remained after adjusting for the smaller body size of the patients. Bone mass was best predicted by mobility rating. CONCLUSIONS: Children with RDEB and JEB have low bone mass after adjusting for their smaller size, which may put them at risk for fragility fractures. Low bone mass was best predicted by the level of mobility, raising the hypothesis that improving activity or bone loading may be a potential preventive intervention in these children. However, as low bone mass may be multifactorial in these children, more detailed investigation of potential aetiological factors is required before interventions are planned.

Absorptiometry, Photon↗

PubMed2006

Measuring body composition.

Several aspects of body composition, in particular the amount and distribution of body fat and the amount and composition of lean mass, are now understood to be important health outcomes in infants and children. Their measurement is increasingly considered in clinical practice; however, paediatricians are often unsure as to which techniques are appropriate and suitable for application in specific contexts. This article summarises the pros and cons of measurement technologies currently available for paediatric application. Simple techniques are adequate for many purposes, and simple regional data may often be of greater value than "whole body" values obtained by more sophisticated approaches.

Absorptiometry, Photon↗

PubMed2005

Randomised, double blind trial of oxytocin nasal spray in mothers expressing breast milk for preterm infants.

BACKGROUND: Human milk has considerable short and long term benefits for preterm infants, but mothers may experience difficulties in expressing breast milk for infants too immature or sick to breast feed. Oxytocin has been used to assist breast feeding and milk expression, but few data are available to support this intervention in the neonatal unit setting. AIM: To test the hypothesis that oxytocin nasal spray increases early milk output in mothers expressing milk for preterm infants. METHODS: A randomised, double blind trial of oxytocin nasal spray (100 microl per dose) versus placebo was conducted in mothers delivering infants <35 weeks gestation. Sprays were used before expression of milk using an electric pump up to day 5. MAIN OUTCOME: Total weight of milk expressed while using spray (study powered to detect >1SD difference between groups). SECONDARY OUTCOMES: Pattern of milk production; number of pumping sessions; weight/fat content of milk expressed during a fixed 20 minute period on day 5 ("physiological study"); mother's opinion of expressing and spray assessed by questionnaire. RESULTS: Fifty one mothers were randomised (27 oxytocin, 24 placebo). Total milk production did not differ between groups. Repeated measures analysis of variance suggested significantly (p = 0.001) different patterns of milk production, with initial faster production in the oxytocin group then convergence between groups. Parity did not influence the response to the intervention. No significant differences were seen in milk weight or fat content in the physiological study nor in mothers' opinions of milk expression and treatment. CONCLUSIONS: Despite marginal differences in the pattern of early milk production, the use of oxytocin nasal spray did not significantly improve outcome. Most mothers believed they were receiving the active spray, suggesting a significant placebo effect (supported by limited data from historical controls) and benefits from the extra breast feeding support available during the study.

Administration, Inhalation↗

PubMed2005

Dual X-ray absorptiometry (DXA) of the lumbar spine in a clinical paediatric setting: does the method of size-adjustment matter?

UNLABELLED: Dual X-ray absorptiometry (DXA) is increasingly used in a clinical setting to evaluate bone mass in children. Areal Bone Mineral Density (aBMD) measurements are known to be influenced by body size, but there is no consensus on the optimal way to deal with this for individual patients. AIM: To compare parameters of bone mass with varying degrees of size correction and to determine the effect on the categorisation of patients as normal or abnormal. SUBJECTS AND METHODS: Healthy children (n = 78) and 4 groups of patients (n = 194) underwent DXA scans of the lumbar spine (L2-4, GE Lunar Prodigy). Five measures of bone mass were derived, all adjusted for age and sex: aBMD, BMAD (BMC/BA (1.5)), BMCh (BMC/height3), BMCa (BMC adjusted for BA), BMCt (BMC adjusted for BA and height). SD scores were calculated for each parameter for patients using data from healthy controls. RESULTS: Compared to healthy children, all patient groups had significantly reduced BMD SD scores (P < 0.001). Mean BMAD, BMCa and BMCt SD scores were significantly lower in only 2/4 patient groups, whilst BMCh SD scores were low only in one group. BMCt showed no advantage over BMCa. The proportion of patients with SD scores <-2 was 27% for aBMD but between 10-13% for BMAD, BMCh and BMCa. CONCLUSIONS: All size-corrected parameters of bone mass performed similarly and classified significantly fewer patients as abnormal than did aBMD. The use of one of these parameters should reduce the number of patients diagnosed inappropriately with 'low bone mass'. However, without validation against an outcome measure or 'gold standard' of bone density or structure, it is not possible to determine which parameter is most correct.

Absorptiometry, Photon↗

PubMed2005

Composition of the fat-free mass in obese and nonobese children: matched case-control analyses.

OBJECTIVE: Most body composition techniques assume constant properties of the fat-free mass (FFM), such as hydration, density and mineralisation. Previous studies suggested that FFM composition may change in childhood obesity; however, this issue has not been investigated in detail. AIM: To compare FFM composition in obese and nonobese children. DESIGN: Observational matched case-control analyses. SUBJECTS: A total of 28 obese children (13 boys, 15 girls) and 22 nonobese children (10 boys, 12 girls) aged 7-14 y. Obesity was defined as body mass index centile >95. METHODS: Measurements were made of weight, height, total body water, and body volume. Bone mineral content was estimated in a subsample. Body composition was calculated using three- and four-component models. RESULTS: According to the three-component model (n=22 matched pairs), obese children had greater hydration (P<0.05), and reduced density (P=0.057) of FFM. According to the four component model (n=11 pairs), obese children had greater hydration (P<0.01) and reduced density (P<0.002) of FFM. The mineralisation of FFM was increased, but not significantly so. CONCLUSION: The greater hydration and reduced density of FFM of obese children should be taken into account if body composition is to be measured with optimum accuracy during treatment programmes. These differences may be addressed by using multicomponent rather than two-component models of body composition. Although the greater mineralisation of FFM in obese children was not significant in the present study, the four-component model is best able to address the combined differences in hydration and mineralisation that occur in childhood obesity.

Absorptiometry, Photon↗

PubMed2005

Prediction of total body water in infants and children.

BACKGROUND: In paediatric clinical practice treatment is often adjusted in relation to body size, for example the calculation of pharmacological and dialysis dosages. In addition to use of body weight, for some purposes total body water (TBW) and surface area are estimated from anthropometry using equations developed several decades previously. Whether such equations remain valid in contemporary populations is not known. METHODS: Total body water was measured using deuterium dilution in 672 subjects (265 infants aged <1 year; 407 children and adolescents aged 1-19 years) during the period 1990-2003. TBW was predicted (a) using published equations, and (b) directly from data on age, sex, weight, and height. RESULTS: Previously published equations, based on data obtained before 1970, significantly overestimated TBW, with average biases ranging from 4% to 11%. For all equations, the overestimation of TBW was greatest in infancy. New equations were generated. The best equation, incorporating log weight, log height, age, and sex, had a standard error of the estimate of 7.8%. CONCLUSIONS: Secular trends in the nutritional status of infants and children are altering the relation between age or weight and TBW. Equations developed in previous decades significantly overestimate TBW in all age groups, especially infancy; however, the relation between TBW and weight may continue to change. This scenario is predicted to apply more generally to many aspects of paediatric clinical practice in which dosages are calculated on the basis of anthropometric data collected in previous decades.

Adolescent↗

PubMed2004

Does weaning influence growth and health up to 18 months?

BACKGROUND: National and international recommendations for the age of introducing solid foods (weaning) are founded on insufficient evidence and little is known about the short and medium term consequences associated with early or late weaning. AIMS AND METHODS: Data from over 1600 infants from five prospective randomised trials conducted in the UK between 1993 and 1997 were used to determine the influence of weaning < or =12 weeks or >12 weeks on growth and health outcomes (diarrhoea and vomiting, lower respiratory chest infections, atopy, sleep patterns) up to 18 months post-term, in term appropriate for gestational age (AGA), term small for gestational age (SGA), and preterm infants. RESULTS: Term infants weaned < or =12 weeks were heavier at 12 weeks of age than those weaned after 12 weeks, but showed slower gain in weight, length, and head circumference between 12 weeks and 18 months than those weaned after 12 weeks; by 18 months, there were no significant differences in size between the two groups. A similar pattern was seen in preterm infants. Breast fed term infants were more likely to be sleeping though the night at 9 months if they were weaned before 12 weeks. No weaning effects or interactions were observed for health outcomes. CONCLUSIONS: We found little evidence that weaning before or after 12 weeks influences health outcomes up to 18 months. Early weaned infants were larger at 12 weeks than later weaned infants but the growth trajectories of the two groups "converged" by 18 months. These findings do not exclude the later emergence of programmed effects of weaning practices.

Animals↗

PubMed2003

Evaluation of air-displacement plethysmography in children aged 5-7 years using a three-component model of body composition.

The aim of the present study was to evaluate air-displacement plethysmography (ADP) in children aged 5-7 years. Body-composition measurements were obtained by ADP, (2)H dilution and anthropometry in twenty-eight children. Calculation of body volume by ADP was undertaken using adult and children's equations for predicting lung volume and surface area. Fat-free mass (FFM) was calculated using a three-component model. Measured FFM hydration was then compared with values from the reference child. Differences between measured and reference hydration were back-extrapolated, to calculate the error in ADP that would account for any disagreement. Propagation of error was used to distinguish the contributions of methodological precision and biological variability to total hydration variability. The use of children's equations influenced the results for lung volume but not surface area. The mean difference between measured and reference hydration was 0.6 (sd 1.7) % (P<0.10), equivalent to an error in body volume of 0.04 (sd 0.20) litres (P<0.30), and in percentage fat of 0.4 (sd 1.9) (P<0.28). The limits of agreement in individuals could be attributed to methodological precision and biological variability in hydration. It is concluded that accuracy of ADP was high for the whole group, with a mean bias of <0.5 % fat using the three-component model, and after taking into account biological variability in hydration, the limits of agreement were around +/-2 % fat in individuals. Paediatric rather than adult equations for lung volume estimation should be used.

Body Composition↗

PubMed2003

Bone densitometry in children assessed by dual x ray absorptiometry: uses and pitfalls.

The importance of bone growth and mineralisation during childhood for bone health in adult life is increasingly accepted, with both nutritional factors(1) and exercise(2) being recognised as influential for normal skeletal development. The appreciation that infancy and childhood are important periods of life for bone development has led to a need for suitable methods for monitoring bone health, both for research purposes and for clinical monitoring of individuals, and hence to an increasing use of bone densitometry in children. This review discusses the role and potential pitfalls of this technique.

Absorptiometry, Photon↗

PubMed2003

Factors associated with weaning in full term and preterm infants.

BACKGROUND: The optimal age for the introduction of solid foods (weaning) in infants is poorly researched yet may have implications for both short and longer term health. Many parents do not comply with current guidelines. OBJECTIVE: To determine and compare the age at weaning in term appropriate size for gestational age (AGA), small for gestational age (SGA), and preterm infants, and factors associated with weaning age in these groups. DESIGN: Data from > 2000 infants from seven prospective randomised trails conducted between 1990 and 1997 were used to address the objectives. RESULTS: Most infants, term AGA, SGA, or preterm, received solids before 4 months of age. Only 2% of term infants were exclusively breast fed to 6 months of age. Formula fed infants received solids on average two weeks earlier than breast fed infants. Preterm infants were significantly more likely, and term SGA infants less likely, to receive solids at both 6 and 12 weeks after term than term AGA infants. Weight at 6 weeks of age was a stronger predictor of earlier weaning than either birth weight or weight gain from birth to 6 weeks in term infants. In preterm infants, formula feeding and maternal smoking were associated with earlier weaning. CONCLUSIONS: Infants born in the mid 1990s were weaned on average earlier than the 4 months recommended by the Department of Health. Earlier weaning was associated with less positive health behaviours. Further research is required to provide evidence based weaning guidelines, including specific advice for SGA and preterm infants, and to investigate longer term consequences of weaning practices.

Birth Weight↗

PubMed2003

Cholesterol metabolism in 8 to 12-year-old children born preterm or at term.

UNLABELLED: Studies in animals have indicated that cholesterol metabolism is susceptible to manipulation by diet and growth in early life. In humans, low birthweight has been associated with increased risk of coronary heart disease. AIM: To establish whether plasma lipids and indicators of cholesterol absorption, synthesis and breakdown differ in children born preterm and at term. METHODS: Plasma total cholesterol, high density lipoprotein (HDL) cholesterol, low density lipoprotein (LDL) cholesterol, triacylglycerols, apolipoprotein A1, apolipoprotein B, lathosterol (indicator of cholesterol synthesis), campesterol (indicator of cholesterol absorption), 7-alpha hydroxycholesterol (indicator of cholesterol breakdown) were measured in up to 407 children born preterm and 36 children born at term. RESULTS: Children born preterm had lower cholesterol synthesis (p = 0.002) and lower cholesterol breakdown (p < 0.001) than those born at term, but their plasma cholesterol concentration was not significantly different. After adjusting for current size, birthweight and gestational age were significantly related to plasma lathosterol and 7-alpha hydroxycholesterol. However, when both birthweight and gestational age were adjusted, only gestational age remained significant. There were no significant differences in plasma campesterol between the two groups. CONCLUSION: Being born preterm may have a long-term effect on cholesterol metabolism in children 8-12 y later. Those born prematurely had lower cholesterol synthesis and breakdown, but their plasma cholesterol concentration was similar at this age. These parameters need to be studied in older cohorts.

Birth Weight↗

PubMed2002

Segmental bioelectrical impedance analysis in children aged 8-12 y: 1. The assessment of whole-body composition.

OBJECTIVES: To investigate the potential of segmental bioelectrical impedance analysis (BIA) for estimating whole-body composition in children. DESIGN: Strengths of relationships were determined between indices of impedance or specific resistivities of body segments and reference four-component model (4-CM) assessments of body composition. SUBJECTS: Eighteen boys and 19 girls aged 8-12 y. MEASUREMENTS: Whole-body and segment BIA and anthropometry were used to calculate impedance indices of the whole body and segments and specific resistivities of segments; total body water (TBW), fat-free mass (FFM) and body fat were assessed using the 4-CM. RESULTS: Segmental BIA indices were significantly related to body composition, provided that appropriate comparisons were undertaken for each index: impedance adjusted for unit segment length was better related to TBW and FFM, whereas segment specific resistivity was better related to body fat. Differences between body composition estimates obtained with the 4-CM and predicted using BIA were partly dependent on limb-to-trunk ratios of BIA indices. CONCLUSION: Segmental BIA has potential for providing additional alternative approaches to the assessment of whole-body composition in children: (a) FFM and TBW were best related to impedance adjusted for segment length; (b) body fat was best related to segment specific resistivity; and (c) the relative influences of different segment BIA indices may be utilisable for generating more valid whole-body composition estimates.

Adipose Tissue↗

PubMed2002

Segmental bioelectrical impedance analysis in children aged 8-12 y: 2. The assessment of regional body composition and muscle mass.

OBJECTIVES: To investigate the potential of segmental bioelectrical impedance analysis (BIA) for assessing regional composition and muscle mass in children. DESIGN: Strengths of relationships were determined between (a) BIA indices of trunk, limbs or limb segments and (b) segment fat or fat-free mass (FFM) assessed using dual-energy X-ray absorptiometry (DXA); the extent of agreement was established between two independent models, based on DXA and BIA, of limb muscle and adipose tissue (AT) mass. SUBJECTS: Eighteen boys and 19 girls aged 8-12 y. MEASUREMENTS: BIA and anthropometry of trunk, whole limbs, limb segments and defined sections were used to calculate segmental impedance indices and specific resistivities; segment fat and FFM were obtained using DXA; muscle and AT masses of limbs, segments and sections were estimated using DXA and BIA models, and by anthropometry. RESULTS: Segmental BIA indices were significantly related to composition of the segments assessed using DXA; although substantial bias was observed, there was fairly good agreement (low 95% limits of agreement) between the BIA and DXA models of muscle mass and estimates from each were similarly categorised in tertiles, as were estimates of AT. CONCLUSION: Segmental BIA appears to have potential for assessing in children the composition of body segments, as obtained using DXA, and the masses of muscle and AT in whole limbs, limb segments and defined sections.

Absorptiometry, Photon↗

PubMed2001

Catch-up growth in small-for-gestational-age term infants: a randomized trial.

BACKGROUND: Small-for-gestational-age (SGA) term infants are at risk of long-term growth deficits. OBJECTIVE: The objectives were to test the hypothesis that postnatal growth in SGA term infants can be altered by dietary intervention and to examine whether there is a critical window for nutritional programming of the growth trajectory during the first 9 mo postnatally. DESIGN: Healthy term (gestation > or =37 wk) infants with birth weights below the 10th centile were randomly assigned to receive standard term formula (TF; n = 147) or nutrient-enriched formula (EF; n = 152) for the first 9 mo; 175 breast-fed SGA term infants formed a reference group. The main outcome measures were weight, length, and occipitofrontal head circumference (OFC) at 9 and 18 mo. RESULTS: The infants fed the EF showed greater gains in length by 9 (1.1 cm; 95% CI: 0.38, 1.79) and 18 (1.0 cm; 0.25, 1.83) mo and in OFC by 9 (0.5 cm; 0.1, 0.9) and 18 (0.6 cm; 0.2, 1.1) mo than did infants fed the TF; the differences were larger in females. The dietary effects were independent of the pattern of growth retardation. Breast-fed infants showed greater gains in weight and OFC by 18 mo than did infants fed the TF; however, these differences disappeared after adjustment for age, parental size, and birth order. CONCLUSIONS: Linear growth and OFC gains in SGA term infants improve after nutritional intervention during the first 9 mo of life and the effects persist for > or =9 mo beyond the intervention period. Further information on whether catch-up growth is beneficial or detrimental to long-term outcomes is required before public health interventions can be recommended.

Analysis of Variance↗

PubMed2001

Birth weight, subsequent growth, and cholesterol metabolism in children 8-12 years old born preterm.

AIMS: To test the hypothesis that plasma lipids, lipoproteins, and markers of cholesterol biosynthesis (lathosterol) and absorption efficiency (campesterol) in children aged 8-12 years are related to birth size and subsequent growth. METHODS: A total of 412 girls and boys weighing less than 1850 g at birth were studied. Birth weight, gestation, and weight at 18 months were recorded and followed up at 8-12 years. Plasma total cholesterol, low density lipoprotein cholesterol, high density lipoprotein cholesterol, apolipoprotein A1, apolipoprotein B, triacylglycerol, lathosterol, and campesterol were measured. RESULTS: Birth weight for gestational age was positively related to plasma campesterol, and remained so after adjusting for current body size or fatness. Birth weight was negatively related to current plasma lathosterol but only after adjusting for current body size or fatness. For both lathosterol and campesterol the significant relation with birth size adjusted for current size indicates that the change in size between these points (postnatal upward centile crossing) was influential. These relations were absent for total cholesterol, lipoproteins, apolipoproteins, and triacylglycerol. CONCLUSION: Preterm children who were smaller for gestational age at birth had lower predicted cholesterol absorption efficiency 8-12 years later. Among children of the same current size, predicted endogenous cholesterol synthesis was higher and cholesterol absorption efficiency lower in those who showed the greatest increase in weight centile between birth and follow up. This finding was not confined to children with the smallest birth weights for gestational age. We suggest that both fetal and childhood growth relate to programming of cholesterol metabolism in children born preterm.

Apolipoproteins A↗

PubMed2001

Randomized trial comparing the efficacy of a novel manual breast pump with a standard electric breast pump in mothers who delivered preterm infants.

OBJECTIVE: The benefits of human milk for preterm infants are widely recognized, yet technological advances in milk expression have been slow. We compared the efficacy of a standard electric pump (EP; Egnell) used in 94% of United Kingdom neonatal units with a novel manual pump (MP; Avent ISIS) designed to operate more physiologically by simulating the infant's compressive action on the areola during breastfeeding. METHODS: We randomized 145 women who delivered infants of <35 weeks' gestation to use the MP or the EP and measured total milk volume expressed while using the randomized pump during the infant's hospital stay, pattern of milk output and creamatocrit of milk expressed during a test period in the second week, and pump characteristics by maternal questionnaire. RESULTS: Mothers who used the EP, who frequently double pumped, showed shorter expression times but produced no more milk than mothers who used the MP. When both pumped sequentially, however, mothers who used the MP showed significantly greater milk flow and total volume over 20 minutes. Creamatocrit was unaffected by pump type. The MP was rated significantly higher than the EP on 5 major characteristics. CONCLUSIONS: When compared on equal terms (sequential pumping), mothers who used the MP showed greater milk flow, perhaps reflecting more physiologic pump design. Even with double pumping, mothers who used the EP did not advantage their infants with greater milk production. We believe that this novel, effective MP, preferred by mothers and costing a fraction of the EP price, reflects a significant advance in milk expression for high-risk infants.breast pumps, randomized trial, preterm infants.

Breast↗

PubMed2001

Randomized trial of nutrient-enriched formula versus standard formula for postdischarge preterm infants.

OBJECTIVES: Preterm infants are frequently discharged from the hospital growth retarded and show reduced growth throughout childhood. In a large efficacy and safety trial, we tested the hypothesis that nutritional intervention in the first 9 months postterm would reverse postdischarge growth deficits and improve neurodevelopment without adverse safety outcomes. PARTICIPANTS AND INTERVENTION: Two hundred eighty-four infants (mean gestation: 30.9 weeks) were studied; 229 were randomly assigned a protein, energy, mineral, and micronutrient-enriched postdischarge formula (PDF; N = 113) or standard term formula (TF; N = 116) from discharge (mean 36.5 weeks' postmenstrual age). A reference group (N = 65) was breastfed until at least 6 weeks' postterm. Outcome measures. Anthropometry was performed at 6 weeks and 3, 6, 9, and 18 months. Development was measured at 9 months (Knobloch, Passamanick, and Sherrard's developmental screening inventory) and 18 months (Bayley Scales of Infant Development II; primary outcome) postterm. RESULTS: At 9 months, compared with the TF group, those fed PDF were heavier (difference 370 g; 95% confidence interval [CI]: 84-660) and longer (difference 1.1 cm; 95% CI: 0.3-1.9); the difference in length persisted at 18 months (difference 0.82 cm; 95% CI: -0.04-1.7). There was no effect on head circumference. The effect of diet was greatest in males; at 9 months length deficit with TF was 1.5cm (95% CI: 0.3-2.7), and this remained at 18 months (1.5cm [95% CI: 0.3-2.7]). There was no significant difference in developmental scores at 9 or 18 months, although PDF infants had a 2.8 (-1.3-6.8) point advantage in Bayley motor score scales. At 6 weeks' postterm, exclusively breastfed infants were already 513 g (95% CI: 310-715) lighter and 1.6cm (95% CI: 0.8-2.3) shorter than the PDF group, and they remained smaller up to 9 months' postterm. CONCLUSIONS: 1) Improving postdischarge nutrition in the first 9 months may "reset" subsequent growth-at least until 18 months for body length. We intend to follow-up the children at older ages. The observed efficacy of PDF was not associated with adverse safety outcomes. 2) We cannot reject the hypothesis that postdischarge nutrition benefits motor development and this requires additional study. 3) Our data raise the possibility that breastfed postdischarge preterm infants may require nutritional supplementation, currently under investigation.

Anthropometry↗