Associations of Growth and Body Composition with Brain Size in Preterm Infants

Katherine A. Bell, Lillian G. Matthews, Sara Cherkerzian, Caroline Palmer, Kaitlin Drouin, Hunter L. Pepin, Deirdre Ellard, Terrie E. Inder, Sara E. Ramel, Mandy B. Belfort

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38 Scopus citations


OBJECTIVE: To assess the association of very preterm infants' brain size at term-equivalent age with physical growth from birth to term and body composition at term.

STUDY DESIGN: We studied 62 infants born at <33 weeks of gestation. At birth and term, we measured weight and length and calculated body mass index. At term, infants underwent air displacement plethysmography to determine body composition (fat and fat-free mass) and magnetic resonance imaging to quantify brain size (bifrontal diameter, biparietal diameter, transverse cerebellar distance). We estimated associations of physical growth (Z-score change from birth to term) and body composition with brain size, adjusting for potential confounders using generalized estimating equations.

RESULTS: The median gestational age was 29 weeks (range, 24.0-32.9 weeks). Positive gains in weight and body mass index Z-score were associated with increased brain size. Each additional 100 g of fat-free mass at term was associated with larger bifrontal diameter (0.6 mm; 95% CI, 0.2-1.0 mm), biparietal diameter (0.7 mm; 95% CI, 0.3-1.1 mm), and transverse cerebellar distance (0.3 mm; 95% CI, 0.003-0.5 mm). Associations between fat mass and brain metrics were not statistically significant.

CONCLUSIONS: Weight and body mass index gain from birth to term, and lean mass-but not fat-at term, were associated with larger brain size. Factors that promote lean mass accrual among preterm infants may also promote brain growth.

Original languageEnglish (US)
Pages (from-to)20-26.e2
JournalJournal of Pediatrics
StatePublished - Nov 2019

Bibliographical note

Funding Information:
Supported by a Marshall Klaus Perinatal Research Award from the American Academy of Pediatrics (to K.B.); the Brigham Research Institute and Brigham and Women's Hospital Stork Fund (to M.B.); Program for Interdisciplinary Neuroscience Traveling Fellowship from the Brigham and Women's Hospital (to L.M.); and by Clinical Translational Science Award UL1RR025758 to Harvard University and Brigham and Women's Hospital from the National Center for Research Resources. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Center for Research Resources or the National Institutes of Health. The authors declare no conflicts of interest.

Publisher Copyright:
© 2019 Elsevier Inc.


  • air displacement plethysmography
  • body composition
  • brain metrics
  • preterm

PubMed: MeSH publication types

  • Journal Article


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