Bigger not necessarily better

Article Outline

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In this issue of The Journal, Olsen et al investigate the value of weight-for-length to measurement of weight-for-gestational age as a routine assessment of growth status in infants on admission and then again at the time of discharge from neonatal intensive care units (NICUs). They observed that the percentage of small-for-length infants decreased from 10% on admission to 4% at discharge, the percentage of large-for-age infants remained similar (<1%), and the percentage of large for-length infants increased from 5% to 17%. The shift from small and appropriate-for-length to large-for-length may be a result of accelerated weight gain, poor linear growth, or a combination both. It is widely believed, and supported by studies in the literature, that this change represents an increase in adiposity. This is an important clinical question for nutritional management of preterm infants. Is this beneficial or deleterious? What are the long-term consequences of these changes in body proportionality for health and body composition? Attention to body proportionality in growing VLBW infants, rather than solely monitoring weight for post-menstrual age alone, is a more functional approach for NICU nutrition. This study should stimulate prospective investigations of neonatal body composition with different dietary regimens and long-term follow up.