161 Body composition measurement methods in preterm infants 7 On the contrary, isotope dilution can be used in small infants who aren’t stable yet, making it very suitable for use in the NICU - were it not that it has a relatively high workload. In addition, oral administration of the isotope solution is challenging in older infants. MRI is yet to become a widely usedmethod tomeasure fat mass in preterm infants, but seems promising with high precision. Furthermore, MRI is a safe, radiationfree method. Nevertheless, infants on respiratory support and monitoring cannot easily undergo an MRI procedure. All-in-all, at this time there is no prospect of an accurate, easy, low-cost point of care instrument which could be used during the NICU stay or the follow-up period in a clinical setting. In a research setting ADP may be the most practical, yet reliable, method to use in infants up to 6 months corrected age. Limitations This review included all potential reference methods, which made it challenging to come to a concise conclusion. Furthermore, it is important to note that, overall, validation studieswere conducted in a limitednumber of study subjectswith awide range of gestational ages and varying postnatal ages at the time of assessment. Hence, it was even more difficult to draw definitive conclusions on the assessment of body composition at different gestational and postnatal ages. Moreover, the reference methods used in the various studies have not been validated in humans, or were only validated in a small number of subjects. This lack of a solid golden standard further undermines any conclusions drawn from these studies. In addition, only formally published data was included, leaving potential publication bias unassessed. There is a need for larger cross-sectional studies comparing these instruments at different time points as well as longitudinal studies investigating the accuracy of the use of the instruments over time. Conclusions Monitoring body composition remains important in the light of the increased cardiometabolic disease risk in adults born prematurely.1-7 Therefore the quest for accurate but also practical methods to assess body composition should continue. This review reaffirmed that weight and length indices, body area circumferences, SFT, BIA and ultrasound do not adequately reflect body composition. MRI looks promising for the use in preterm infants, but hasn’t been validated for the measurement of body composition. On the other hand, DXA, ADP and isotope dilution methods are considered trustworthy and validated techniques. Nevertheless, this review showed that these methods may not yield comparable results. Therefore, caution should be taken when comparing body composition measuredwith differentmethods. Moreover, to facilitate future studies and support
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