# Standardizing Neonatal Body Composition Assessment Using Air Displacement Plethysmography: Insights from the Bavarian Experience

## TL;DR

This study shows that air displacement plethysmography can be safely and effectively used in routine neonatal care to assess body composition, using a standardized Bavarian protocol.

## Contribution

The Bavarian Clinical Protocol is introduced as a standardized framework for ADP in neonatal care, improving data comparability and clinical utility.

## Key findings

- 89.1% of eligible infants underwent ADP assessments after implementing the Bavarian Clinical Protocol.
- No adverse events were observed in 8,317 ADP assessments across 76 studies.
- The protocol was successfully integrated into clinical workflows without disruption.

## Abstract

Background/Objectives: Body composition plays a crucial role in neurodevelopment and the long-term health of preterm and term infants. Air displacement plethysmography (ADP), especially with the PEAPOD® system, is well established in research and increasingly explored in clinical practice. Building on our team’s earlier experiences, this study aimed to (1) evaluate the safety and feasibility of ADP in preterm infants, (2) identify published clinical protocols, and (3) implement and assess a standardized routine—the Bavarian Clinical Protocol (BCP). Methods: We conducted two systematic literature reviews: one on the eligibility-to-assessment rate and safety of ADP in research contexts, and a second focusing on existing clinical protocols. In addition, we retrospectively analyzed routine ADP assessments at the NICU of Nuremberg Children’s University Hospital from January 2022 to December 2024, where the BCP had been introduced. Results: The literature review included 76 studies reporting a total of 8,317 assessments without adverse events. In experimental settings, the eligibility-to-assessment rate was 41%. We identified three published clinical protocols. Following BCP implementation, 626 of 702 eligible infants (89.1%) underwent a total of 851 ADP measurements. No adverse events were observed, and repeated assessments were integrated smoothly into clinical workflows. Conclusions: ADP can be safely and effectively incorporated into neonatal routine care. The Bavarian Clinical Protocol provides a practical framework for standardized application, improves comparability across centers, and supports the clinical use of body composition data to inform individualized nutritional strategies.