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How is bioelectrical impedance used in neonatal intensive care? A scoping review
D L McCarter1,2, C Morgan3, L Bray4
1Neonatal Intensive Care Unit, Liverpool Women's Hospital, Crown St, Liverpool, L8 7SS, UK. Diane.McCarter@lwh.nhs.uk.
Insights
Bioelectrical impedance analysis (BIA) is a non-invasive technology now available for preterm infants. While BIA shows promise for assessing fluid status, nutrition, and growth in neonatal intensive care units, more research is needed to confirm its clinical benefits.
Area of Science:
- Neonatal intensive care
- Bioelectrical impedance analysis
- Body composition assessment
Background:
- Neonatal growth and nutrition significantly impact infant outcomes.
- Current clinical decisions rely on vital signs, fluid balance, weight trends, and physical exams.
- Bioelectrical Impedance Analysis (BIA) is a non-invasive body composition tool now available for infants from 23 weeks gestation.
Purpose of the Study:
- To explore the utilization of bioelectrical impedance in preterm and sick term infants within the neonatal intensive care unit.
- To identify the situations and timing of BIA application in this population.
Main Methods:
- A scoping review was conducted using Arksey and O'Malley's framework.
- 16 papers were included from an initial 49 identified.
- Studies comprised 3 experimental and 13 observational designs.
Main Results:
- BIA is utilized in neonatal intensive care for fluid status evaluation.
- BIA serves as a measure of adequate nutrition and growth.
- The technology is used to validate BIA as an outcome measure in neonates.
Conclusions:
- There is a lack of recent, robust research on BIA in preterm neonates.
- Technological advancements limit the applicability of older studies.
- While potentially helpful for fluid and nutrition management, clinical benefit beyond standard care requires more evidence.
Abstract:
Poor growth and nutrition management in the neonatal period can have a negative impact upon both the short- and long-term outcomes for the infant. Improvements in bioelectrical impedance technology and accompanying licencing agreements now make this enhanced device available for use in infants as small as 23 weeks gestational age. An exploration of this technology and its use is now timely. The aim of the scoping review was to answer the following question: in preterm and sick term infants in the neonatal intensive care unit, how is bioelectrical impedance being utilized, in what situations, and when? The scoping review was conducted using Arksey and O'Malley's (Int J Soc Res Methodol 8(1):19-32, 2005) framework. Forty-nine papers were initially identified and 16 were included in the scoping review. Three studies were experimental designs, and 13 were observational studies. The review found that BIA was used in neonatal intensive care in three main ways, for, (1) fluid status evaluation, (2) as a measure of adequate nutrition and growth, (3) to validate the technology as an outcome measure in neonates.
Conclusion:
There is a paucity of recent robust research papers which investigate the use of bioelectrical impedance in preterm neonates. Available evidence spans a range of 30 years, with technological advancement reducing the application of older studies to the modern neonatal setting. Although this technology may be helpful for decision-making around fluid management and nutrition, in preterm infants, robust evidence is needed to demonstrate the clinical benefit of bioelectrical impedance beyond that of usual care.
What Is Known:
• Clinical decisions regarding neonatal nutrition and fluid management are currently based upon the interpretation of vital signs, fluid balance, weight trend, biochemical markers, and physical examination. • Bioelectrical Impedance Analysis (BIA) is a non-invasive method of assessing body composition which is now available to be used in infants as small as 23 weeks gestation.
What Is New:
• Bioelectrical Impedance has been used in three main ways in the NICU, for fluid status evaluation, for measuring nutrition and growth and to validate BIA as an outcome. • There is a lack of recent robust research data to support the use of the device within clinical decision making in neonatal intensive care.
