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Updated: May 9, 2026
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Fat-free mass is associated with neurodevelopment outcomes in extremely preterm infants up to 3 years of age
Christoph Binder1, Elisabeth Calek2, Alexandra Thajer2
1Comprehensive Center for Pediatrics, Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Intensive Care and Neuropediatrics, Medical University of Vienna, Vienna, Austria. christoph.a.binder@meduniwien.ac.at.
Insights
Early fat-free mass (FFM) in extremely preterm infants predicts better neurodevelopment up to age three. Focusing on FFM, not just fat mass or growth faltering, is key for long-term outcomes.
Area of Science:
- Neonatalogy
- Pediatric Nutrition
- Developmental Pediatrics
Background:
- Extremely preterm infants are vulnerable to growth issues and developmental delays.
- Adequate growth is crucial for neurodevelopment, but optimal nutritional strategies remain unclear.
- Body composition, especially fat-free mass (FFM), is linked to brain size but its long-term neurodevelopmental impact is unknown.
Purpose of the Study:
- To examine the association between early body composition, growth, and neurodevelopment in extremely preterm infants.
- To determine if early body composition predicts long-term neurodevelopmental outcomes.
Main Methods:
- A cohort of 105 infants born before 28 weeks gestation was studied.
- Body composition was assessed at term-equivalent age.
- Neurodevelopmental outcomes were evaluated at 1, 2, and 3 years of age.
Main Results:
- Higher fat-free mass (FFM) Z-scores at term-equivalent age were significantly linked to better neurodevelopmental scores up to 3 years.
- Fat mass Z-scores and growth faltering did not show significant associations with improved neurodevelopment.
- This study is the largest to date linking FFM Z-score to positive neurodevelopmental outcomes in this population.
Conclusions:
- Early body composition, specifically FFM, may predict long-term neurodevelopment in extremely preterm infants.
- Targeted nutritional interventions to promote FFM gains are crucial for optimizing neurodevelopmental outcomes.
- FFM measurement at term-equivalent age can inform clinical practice and support vulnerable infants.
Background:
Extremely preterm infants represent a highly vulnerable population, facing a high risk of growth faltering and adverse neurodevelopment. Despite advances in neonatal care, nutritional strategies to support adequate growth, which is linked to improved neurodevelopment, remain uncertain. Body composition analysis, particularly fat-free mass (FFM), has emerged as a promising tool for evaluating nutritional status, and has been linked to larger brain size. However, its relationship with long-term neurodevelopment, especially in extremely preterm infants, remains unclear.
Methods:
The objective of this study was to investigate the association between early body composition changes, growth faltering, and neurodevelopmental outcomes, in a cohort of extremely preterm infants. This study included 105 infants born <28 weeks of gestation between 2017 and 2021, all of whom underwent body composition assessment at term-equivalent age and neurodevelopmental follow-up assessments at 1, 2, and 3 years of age.
Results:
FFM Z-Score was significantly and independently associated with higher neurodevelopmental scores up to 3 years of age. In contrast, fat mass Z-Score and growth faltering were not significantly associated with improved neurodevelopmental outcomes through 3 years of age.
Conclusion:
These findings suggest that early body composition analysis, particularly FFM, may serve as a potential predictor of long-term neurodevelopment.
Impact:
Measurement of body composition, particularly fat-free mass (FFM), at term-equivalent age is associated with improved neurodevelopmental outcomes in extremely preterm infants. This study represents the largest cohort of extremely preterm infants in which FFM Z-Score rather than fat mass Z-Score, was positively associated with neurodevelopmental outcomes at 1, 2, and 3 years of age. Early gains in FFM appear to be critical for promoting favorable long-term neurodevelopmental outcome, underscoring the importance of targeted nutritional strategies.
