Fat-free mass (FFM) as term-equivalent age predicts neurodevelopment
in extremely preterm infants through 3 years of age
C. Binder et al. (including N. T. Longford)
Abstract
Extremely preterm infants are a highly vulnerable population, facing
an increased risk of growth faltering and adverse neurodevelopmental
outcomes due to their physiological immaturity, brain injuries,
limited nutrient reserves, and high nutrient demands. Despite
advances in neonatal care, optimal nutritional strategies to support
optimal growth, which is closely linked to improved neurodevelopment,
remain under investigation. Body composition analysis, particularly
the assessment of fat-free mass (FFM), has emerged as a promising tool
for evaluating the nutritional status and has been associated with
larger brain size. However, its relationship with long-term
neurodevelopmental outcomes, especially in extremely preterm infants
remains unclear. Therefore, the objective of this study was to
investigate the association between early body composition changes,
growth faltering and neurodevelopmental outcomes up to 3 years of age
in a cohort of extremely preterm infants. This study included 105
infants born at less than 28 weeks of gestation between years 2017 and 2021,
all of whom underwent body composition assessment at term-equivalent
age neurodevelopmental follow-up using Bayley Scales of Infant
Development (BSID-III) at 1, 2, and 3 years of age. FFM z-score was
significantly and independently associated with higher neurodevelopmental
outcomes in any domain through 3 years of age. These findings suggest
that early body composition analysis, particularly FFM, may serve as
a reliable predictor of long-term neurodevelopment. Implementing
individualized nutritional strategies aimed at promoting early FFM
accretion may be crucial for improving neurodevelopmental outcomes
in this high-risk population.
Submitted.
August 2025.