Abstract
Background
The rate of accrual of muscle mass in neonates has not been assessed. We describe the D3-creatine (D3Cr) dilution method, a noninvasive assessment of muscle mass in neonates.
Methods
A total of 76 neonates >26-week-old corrected gestational age were enrolled and measured at 2-week intervals while admitted to a neonatal intensive care unit (NICU). Additional measures at 6 and 12–20 months after initial measurement were obtained if available. An enteral dose of 2 mg D3Cr in 0.5 mL 20% 2H2O was used to determine muscle mass and total body water (TBW).
Results
Muscle mass by the D3Cr method was strongly associated with TBW and body weight (r = 0.9272, p < 0.0001 and r = 0.9435, p < 0.0001 for all time points and r = 0.6661, p < 0.0001 and r = 0.8634, p < 0.0001, respectively, while in the NICU). Change in muscle mass vs. change in body weight, TBW, and length were also strongly correlated.
Conclusions
The D3Cr dilution method provides a noninvasive assessment of muscle mass accrual in neonates, which has not been previously possible and may be an important new tool for the evaluation of nutritional status and normal growth patterns.
Impact
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We describe a noninvasive method for the measurement of skeletal muscle mass neonates.
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At the present time, there is no direct measurement of muscle mass in infants available.
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The D3Cr dilution method is a direct and noninvasive measurement of muscle mass.
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Using a single enteral dose of D3Cr in 2H2O followed by urine and saliva samples, rapid and substantial accrual of muscle mass and TBW is assessed.
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Assessment of muscle mass accrual in premature infants may be a strong indicator of nutritional status.
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Change in muscle mass is strongly related to change in weight and TBW.
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Acknowledgements
We thank Jeanette Asselin, M.S., at the University of California San Francisco Benioff Children’s Hospital at Oakland for early recruitment and enrollment of infants in this study. All phases of this study were supported by the Bill and Melinda Gates Foundation.
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W.J.E., M.H., and M.S. conceptualized and designed the study, interpreted the data, drafted the initial manuscript, and reviewed and revised the manuscript. B.S. and F.I. implemented the study, acquired the data, interpreted the data, and reviewed and revised the manuscript. E.N., K.G., and G.C. acquired the data, interpreted the analysis, and reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
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Competing interests
W.J.E., M.H., and M.S. were employed by Kinemed, Inc. for a period of time during the conduct of this project. W.J.E. and M.H. are listed as co-inventors on the granted patents for the D3-creatine dilution method, but do not own or derive any income from the intellectual property.
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The study was approved by the Oregon Health & Sciences University Medical School and University of California San Francisco Benioff Children’s Hospital at Oakland Institutional Review Boards. Parents provided consent for all infants enrolled in the study.
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Evans, W.J., Scottoline, B., Imam, F. et al. D3-creatine dilution for the noninvasive measurement of skeletal muscle mass in premature infants. Pediatr Res 89, 1508–1514 (2021). https://doi.org/10.1038/s41390-020-01122-w
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DOI: https://doi.org/10.1038/s41390-020-01122-w
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