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Body composition during the first 4 months in infants affected by neonatal abstinence syndrome: a pilot study
Tammy E Corr1, Eric W Schaefer2, Ian M Paul1,2
1Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Department of Pediatrics, Hershey, PA, USA.
Insights
Neonatal abstinence syndrome (NAS) infants show altered body composition early on, but catch up by 16 weeks. More severe NAS may impact long-term growth.
Area of Science:
- Neonatology
- Pediatric Growth and Development
- Body Composition Analysis
Background:
- Neonatal Abstinence Syndrome (NAS) presents with neurologic excitability and autonomic dysfunction, leading to increased metabolic demands and feeding challenges.
- The impact of NAS symptoms and associated behaviors on infant growth and body composition remains largely unknown.
- Understanding these effects is crucial for optimizing care and predicting long-term outcomes for affected newborns.
Purpose of the Study:
- To longitudinally assess serial body composition changes in infants with NAS requiring pharmacologic treatment during the first four months of life.
- To compare body composition trajectories between infants with NAS requiring monotherapy versus multidrug therapy.
- To establish normative data for body composition changes in this vulnerable population.
Main Methods:
- Air displacement plethysmography was utilized to measure serial body composition in infants diagnosed with NAS.
- Fourteen infants meeting specific gestational age and birth weight criteria were included in the study.
- Mixed-effects models were employed to analyze changes in fat percent, fat mass, and fat-free mass over time.
Main Results:
- Infants with NAS demonstrated weekly increases in mean fat percent (1.1%), fat mass (90 g), and fat-free mass (140 g).
- A subgroup requiring multidrug therapy exhibited lower mean fat percent, fat mass, and fat-free mass compared to those on monotherapy.
- Initially smaller and leaner than healthy term infants, NAS infants showed similar growth patterns by 16 weeks.
Conclusions:
- This study provides the first serial body composition data for infants with NAS treated pharmacologically.
- While infants with NAS may be smaller and leaner early in life, they tend to normalize growth by 16 weeks.
- Infants experiencing more severe NAS may be at risk for long-term growth abnormalities, warranting further investigation.
Abstract:
Newborns with neonatal abstinence syndrome (NAS) display symptoms related to neurologic excitability and autonomic dysfunction that result in increased metabolic demands. These infants also exhibit feeding difficulties and/or hyperphagia. Because the effects of these symptoms and behaviors on growth are unknown, we sought to measure serial body composition measurements over the first 4 months in infants with NAS requiring pharmacologic treatment using air displacement plethysmography. Fourteen infants of singleton birth with appropriate-for-gestational-age (AGA) weight and a gestational age of ≥35 weeks and <42 weeks were evaluated. In mixed-effects models, per week, infants increased in mean fat percent by 1.1% (95% confidence interval [CI]: 0.85-1.43), fat mass by 90 g (CI: 70-100), and fat-free mass by 140 g (CI: 130-150). The subgroup of infants (N = 5) requiring multidrug therapy for symptom control had lower mean fat percent (-1.2%, CI: -5.2-2.1), fat mass (-60 g, CI: -25-13), and fat-free mass (-270 g, CI: -610-80) across time compared to infants requiring monotherapy. We are the first to report how body composition measures change over time in a small group of patients with NAS. Infants with NAS were smaller and leaner in the first several weeks compared to previously reported body composition measurements in term infants, but grew similarly to their healthy counterparts by 16 weeks. Infants with more severe NAS may be at risk for abnormalities in longer term growth.
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