Longitudinal follow-up of height up to five years of age in infants born preterm small for gestational age; comparison to full-term small for gestational age infants

OBJECTIVE: This aims to conduct a comparative study of the height catch-up rate in preterm small for gestational age (SGA) infants during early childhood by gestational age and identify the factors affecting short stature in comparison to full-term SGA infants. METHODS: 449 SGA infants (214 full-term infants, 73 infants with gestation of less than 32 weeks, and 162 infants with gestation of more than 32 weeks but less than 37 weeks) from 25 institutions in Japan were assessed for catch-up (> or = -2SD) rate in growth by measuring for length/height at 1 year, 3 years and 5 years of age and the risk factors for no catch-up (< -2SD) at 5 years. RESULTS: The overall length/height catch-up rate was 68% at 1 year, 89% at 3 years and 88% at 5 years. The catch-up rate at 3 and 5 years of age in the group with gestation of less than 32 weeks had a rate of 74%, which was significantly less than the other two groups (approximately 90%). A significant factor associated with short stature at 5 years in the group with gestation of less than 32 weeks was the lower length SD score at time of birth, and for preterm infants born more than 32 weeks of gestation and full-term infants, significant factors were the lower maternal height and head circumference at birth. CONCLUSION: SGA infants born less than 32 weeks of gestation had a higher risk of no catch-up and different factors affecting catch-up compared to preterm SGA infants of gestation more than 32 weeks and full-term SGA infants.     

Growth and development are similar in VLBW children born appropriate and small for gestational age: an interim report on 97 preschool children

AIM: To investigate growth and development in a cohort of children born with very low birth weight (VLBW) treated at a single tertiary neonatal unit. METHODS: We studied 97 children born between January 1995 and July 1997 with BW <1,500 g. At follow-up (mean age 3.7 years) anthropometric data and data on neurological status, motor, speech and language development were collected. Small for gestational age (SGA) was defined as weight and/or length at birth <10th percentile; shortness at follow-up was defined as height <10th percentile. RESULTS: Comparison was made between the appropriate for gestational age (AGA) (n = 46) and SGA (n = 51) groups. At follow-up, 23 AGA and 35 SGA children were short, had a smaller head circumference (-1.9 vs -0.8 SDS), were lighter at birth (BW -1.3 vs -0.7 SDS), and had a higher rate of broncho-pulmonary dysplasia (BPD) (28 vs 12); no differences in neonatal characteristics or neurological status were evident. A higher frequency of motor delay occurred in the 'short' group. Short children also had a smaller head circumference (HC) (-1.6 vs -0.7). Short SGA children had a higher frequency of BPD, smaller HC (-2.1 vs -1.0), and a slightly higher proportion of suspicious neurological findings, motor delay, and speech and language delay (n.s.). CONCLUSIONS: Preterm VLBW infants, whether AGA or SGA at birth, face the risk of being short at preschool age. Height outcome is probably influenced by postnatal factors. Our data also suggest that short stature is associated with developmental difficulties in this population.     

PHYSICAL GROWTH OF 5-YEAR-OLD CHILDREN WITH A LOW BIRTH WEIGHT

Abstract. Bjerre, I. (Department of Paediatrics, Malmö General Hospital, Malmö, Sweden). Physical growth of 5-year-old children with a low birth weight. Stature, weight, circumference of head and osseous development. Acta Paediatr Scand, 64: 33, 1975.–In a prospective investigation of the physical growth of children with a low birth weight, 143 unselected children who weighed less than 2500 g at birth were reviewed at 5 years of age. The children were grouped according to weight relative to gestational age.
Stature and weight were compared with normal curves for Swedish children and with a control series. The circumference of the head was compared with a normal curve. Osseous development was assessed by the method of Eklöf & Ringertz and was compared with their normal values.
Growth of the LBW-children was slightly retarded in respect of stature, weight and osseous development, but not regarding head circumference. The values found for stature and osseous development were low in the group small for gestational age and for twins. Those LBW-children who were appropriate for gestational age developed at a normal rate. This is true even for those with the lowest birth weight and those born long before term.
Osseous development was correlated with stature, which may be due to the measuring method used. Neither maternal disease nor feeding difficulties during the first few months of life had any demonstrable effect on the physical development of the children. Socio-economic factors now surely play at most a subordinate role. Physical development of the children varied most with the mothers' stature and weight and probably with hereditary factors.     

Preterm birth and carotid diameter and stiffness in childhood

BACKGROUND AND AIM: Low birthweight, either as a result of poor foetal growth or preterm birth, is a risk factor for stroke in adult life. Carotid stiffening, an early marker of atheromatous disease, has been found in low-birthweight children born at term. We hypothesized that carotid artery growth and dynamic properties are permanently affected by preterm birth. METHODS: Carotid artery stiffness and dimensions in 56 school children, 39 born very preterm (mean gestational age [GA] 29 weeks) and 17 controls born at term, were studied by ultrasonic measurements of the pulsatile movements of the vessel wall. RESULTS: The carotid artery diameter was 6.4 mm both in children born preterm and at term (p=0.99). No difference in carotid stiffness was found. Within the preterm group, no differences could be seen between those born small for gestational age (SGA) or appropriate for gestational age (AGA). CONCLUSIONS: Carotid artery elasticity and structure are not altered after preterm birth. The mechanisms behind the increased stroke risk in adults born preterm remain unresolved.     

Physical growth of 5-year-old children with a low birth weight. Stature, weight, circumference of head and osseous development.

In a prospective investigation of the physical growth of children with a low birth weight, 143 unselected children who weighed less than 2500 g at birth were reviewed at 5 years of age. The children were grouped according to weight relative to gestational age. Stature and weight were compared with normal curves for Swedish children and with a control series. The circumference of the head was compared with a normal curve. Osseous development was assessed by the method of Ekl?f & Ringertz and was compared with their normal values. Growth of the LBW-children was slightly retarded in respect of stature, weight and osseous development, but not regarding head circumference. The values found for stature and osseous development were low in the group small for gestational age and for twins. Those LBW-children who were appropriate for gestational age developed at a normal rate. This is true even for those with the lowest birth weight and those born long before term. Osseous development was correlated with stature, which may be due to the measuring method used. Neither maternal disease nor feeding difficulties during the first few months of life had any demonstrable effect on the physical development of the children. Socio-economic factors now surely play at most a subordinate role. Physical development of the children varied most with the mothers' stature and weight and probably with hereditary factors.     

Second-generation consequences of small-for-dates birth

This is the first reported study of birth outcomes of a group of women whose own birth weights and gestational ages had been previously recorded. Births occurring from 1972 to 1983 among 1154 Swedish women, born from 1955 to 1965, were studied. Women who were themselves small for gestational age (SGA) at birth were at increased risk of giving birth to a SGA infant (odds ratio = 2.21, 95% confidence interval = 1.41, 3.48). Women who had been SGA had an even greater increase in risk of giving birth to a preterm infant (odds ratio = 2.96, 95% confidence interval = 1.47, 5.94). Women who were preterm at birth were not at increased risk of giving birth to either preterm (odds ratio = 0.65, 95% confidence interval = 0.15, 2.74) or SGA (odds ratio 1.21, 95% confidence interval = 0.62, 2.38) infants. It is concluded that the long-term effects of intrauterine growth retardation may extend to the next generation; women who had been SGA should be considered at increased risk to give birth to both growth-retarded and preterm infants.     

Catch-down growth during infancy of children born small (SGA) or appropriate (AGA) for gestational age with short-statured parents

OBJECTIVE: We analyzed postnatal growth in children with familial short stature (FSS) with regard to small (SGA) or appropriate (AGA) for gestational age status at birth. STUDY DESIGN: We studied 96 otherwise healthy short-statured children (58 males; SGA: n = 41, AGA: n = 55). At least one of the parents was short-statured. Cross-sectional data for length/height and weight for the first 4 years of age were collected retrospectively. RESULTS: AGA children had a mean length of 0.09 +/- 1.02 standard deviation score (SDS) at birth, -1.57 +/- 1.16 SDS after 1 year of age, and -2.36 +/- 0.72 SDS after 4 years. SGA children had a mean length of -2.04 +/- 1.06 SDS at birth, -2.70 +/- 1.12 SDS at 1 year of age, and -3.05+/-0.86 SDS at 4 years. The loss of length SDS within the first 2 years of life was greater in AGA than in SGA children. SGA children were significantly shorter than AGA children at all of the study points (p <.001). CONCLUSIONS: Children with an FSS background born AGA show catch-down growth to their lower familial range during the first 2 years of life. SGA children did not catch up to their AGA peers at any time.     

Stress and lack of social support as risk factors for small-for-gestational-age birth

AIM: To determine the contributions of social support and perceived stress to the risk of small-for-gestational-age birth. METHODS: The investigation was a case-control study of mothers of infants born at 37 or more completed weeks of gestation. Cases weighed less than the sex-specific 10th percentile for gestational age at birth (small for gestational age (SGA), n = 836), and controls (appropriate for gestational age (AGA), n = 870) comprised a random selection of heavier babies. RESULTS: In univariate analyses measures of informal social support, but not perceived stress or formal social support, were associated with SGA birth. It was found that Asian mothers are less likely to receive support from families and friends. After adjustment for ethnicity, informal social support was not associated with SGA. CONCLUSIONS: Support appears to reduce the risk of SGA births, but after adjustment for ethnicity this is no longer the case. Stress during pregnancy was not associated with SGA birth.     

Long term outcome of small versus appropriate size for gestational age co-twins/triplets

BACKGROUND: Small for gestational age (SGA) extremely low birthweight (ELBW < 1000 g) survivors often remain small and/or have subnormal school performance. Some are twins/triplets with larger appropriate size for gestational age (AGA) co-twins/triplets. OBJECTIVE: To assess whether SGA ELBW twins/triplets remain different from their AGA co-twins/triplets.Design, setting: During 1981-1999, 353 SGA ELBW neonates were admitted to our neonatal intensive care unit: 267 survived, 54/267 were twins/triplets, and 36/54 had AGA surviving co-twins/triplets. This longitudinal study describes the growth, neurodevelopmental outcome, and school performance of these 36 sets (3-17 years). The children were classified as normal, or having minor, moderate, or severe deficiencies. RESULTS: Values for birth weight (mean intrapair z score difference 2.26), length (2.74), and head circumference (2.62) were lower in SGA neonates than in AGA co-twins/triplets. SGA survivors remained smaller at 3-6 years of age: mean intrapair z score difference in weight, 1.37, height, 1.54, head circumference, 1.21. From 6 to 17 years, smaller differences persisted. Former SGA children had a tendency to have motor deficiencies (nine SGA v three AGA) and mental retardation (seven v four), same hearing loss (two v two), but significantly more visual abnormalities (15 v 11), behavioural disturbances (14 v five), and speech problems (14 v eight). Twenty four sets were in the same normal level class, often supported by familial/professional help. CONCLUSIONS: Although raised in the same environment, SGA ELBW survivors remained smaller and had more visual/behavioural/speech problems, but most maintained grade level parity with their AGA siblings, with appropriate help.     

Differential effects of intrauterine and postnatal brain growth failure in infants of very low birth weight

We investigated the contribution of brain growth failure to outcome in infants of very low birth weight (VLBW; less than 1.5 kg) who were appropriate for gestational age (AGA; n = 379) or small for gestational age (SGA; n = 102). Growth was assessed at birth, term, and 8 and 20 months' corrected age and results of a Bayley Mental Developmental Index (MDI) and neurologic examination were evaluated at 20 months of age. Both groups had similar 20-month MDI scores (93 vs 90) and similar rates of neurologic impairment (14% vs 10%). More SGA infants (25%) than AGA infants (14%) had a subnormal head circumference at 8 months' corrected age, indicating failure to catch up in head growth. Subnormal head size at 8 months predicted the 20-month MDI score for both groups. However, multivariate analysis indicated that, whereas subnormal 8-month head size was directly associated with the MDI score in AGA children, in SGA children 8-month head size was not significantly related to the MDI score when neonatal illness, neurologic impairment, socioeconomic status, and race were controlled for. We conclude that in AGA VLBW infants, subnormal head size at 8 months results from major neonatal illness and has adverse later effects. In SGA infants, subnormal head size at 8 months has many causes, including growth retardation in utero, which may not have an adverse effect on outcome; if subnormal head size is superimposed with neonatal illness, a poorer outcome is likely.     

Term infants with fetal growth restriction are not at increased risk for low intelligence scores at age 17 years

OBJECTIVE: To assess the long-term cognitive outcome of small for gestational age (SGA) compared with appropriate for gestational age (AGA) infants. DESIGN: Data from the Jerusalem Perinatal Study was matched with information from the army draft medical board. SGA and severe SGA were defined as birth weight below the 10th and 3rd percentiles for gestational age, respectively. A multiple linear regression analysis was performed to control for clinical, perinatal, and socio-demographic confounding variables. SUBJECTS: A cohort of 13,454 consecutive singleton term infants born between 1974 and 1976. Main outcome measure: IQ at age 17 years. RESULTS: SGA infants had lower adjusted mean +/- SE IQ scores compared with their AGA peers: 102.2 +/- 0.9 versus 105.1 +/- 0.7 (P <.0001) for males and 102.5 +/- 0.9 versus 103.9 +/- 0.7 (P <.015) for females. SGA was not associated with lower academic achievements compared with AGA. CONCLUSION: After controlling for multiple confounders, being born SGA at term is associated with slightly lower intelligence test scores at age 17 years. However, the clinical significance of the small difference is not evident in academic achievements.     

足月小于胎龄儿胃饥饿素、胰岛素样生长因子-1及瘦素关系的研究

目的探讨胃饥饿素（Ghrelin）、胰岛素样生长因子-1（IGF-1）及瘦素（Leptin）在足月小于胎龄儿（SGA）中的作用及其关系。方法本院产科出生的足月SGA和适于胎龄儿（AGA）各30例,生后测量体重、身长、头围,并计算体重指数（BMI）,生后第3天测定血Ghrelin、IGF-1及Lep-tin水平。结果 SGA组体重、身长、头围、BMI均明显低于AGA组[（2280±190）g比（3220±320）g,（46.3±1.8）cm比（50.5±2.0）cm,（31.8±1.1）cm比（33.6±1.1）cm,（10.6±0.8）cm比（12.6±0.9）cm,P均〈0.05]。SGA组血清IGF-1及Leptin水平均低于AGA组[（49.6±10.3）μg/L比（55.3±9.9）μg/L,（2.4±0.8）μg/L比（3.0±1.0）μg/L],血浆Ghrelin水平高于AGA组[（25.2±11.0）μg/L比（17.3±7.4）μg/L],P均〈0.05。两组IGF-1与体重呈正相关,Leptin与体重、身长呈正相关,Ghrelin与体重、BMI呈负相关,P均〈0.05。两组Ghrelin水平与IGF-1呈负相关,IGF-1与Leptin呈正相关;SGA组Ghrelin水平与Leptin呈负相关,P均〈0.05。结论生后早期SGA新生儿存在高Ghrelin、低IGF-1、低Leptin水平状态。Ghrelin、IGF-1及Leptin共同参与胎儿宫内营养的调节,相互起协同及拮抗作用。     

The relationship between intrauterine and postnatal growth on the subsequent psychomotor development of very low birthweight (VLBW) infants

ABSTRACT. The aim of this study was to demonstrate the relationship between intrauterine and postnatal growth and subsequent neurological and intellectual development of very low birth weight (VLBW) infants. The effect of intrauterine growth was assessed by comparing the developmental outcomes of the 131 appropriate weight for gestational age (AGA) infants with the 33 small for gestational age (SGA) infants. No significant differences were found between the two groups with respect to head circumference, neurological, intellectual or sensory handicap rates. The mean General Quotient (GQ) at the last clinic assessment for the AGA infants was 101.2 and 97.2 for the SGA infants. The effect of extra-uterine growth on subsequent development was assessed in the AGA and SGA infants separately, at the time of discharge and again at 12 months. The 31 AGA infants who failed to grow adequately in the nursery had more neonatal risk factors than the 100 AGA infants who continued to grow adequately after birth. This early postnatal growth failure was not predictive of developmental outcome. At 12 months of age, 26 infants (20%) who were initially appropriately grown at birth were failing to thrive. These infants had sustained more chronic diseases and caretaking disorders in the first year of life than their appropriately grown counterparts. They also had lower GQ and head circumference measurements (p<.05). The SGA infants who exhibited “catch up'’growth between birth and term had larger head circumference measurements at 1 year than those with persistent growth failure. Growth assessment at 12 months of age was not predictive of developmental outcome in SGA infants. We failed to show a relationship between intrauterine growth of VLBW infants and their subsequent development. AGA infants whose weights had dropped to the 3rd percentile by 12 months of age had a poorer outcome than their appropriately grown counterparts. Furthermore, early postnatal growth failure before term had no additional effects if catch up growth occurred thereafter. In the SGA group neither failure to reach the 3rd percentile by term or 12 months affected outcome.     

Effects of gestation and birth weight on the growth and development of very low birthweight small for gestational age infants: a matched group comparison

AIMS: To investigate the effects of small for gestational age (SGA) in very low birthweight (VLBW) infants on growth and development until the fifth year of life. METHODS: VLBW (< 1500 g) infants, selected from a prospective study, were classified as SGA (n = 115) on the basis of birth weight below the 10th percentile for gestational age and were compared with two groups of appropriate for gestational age (AGA) infants matched according to birth weight (AGA-BW; n = 115) or gestation at birth (AGA-GA; n = 115). Prenatal, perinatal, and postnatal risk factors were recorded, and duration and intensity of treatment were computed from daily assessments. Body weight, length, and head circumference were measured at birth, five and 20 months (corrected for prematurity), and at 56 months. General development was assessed at five and 20 months with the Griffiths scale of babies abilities, and cognitive development at 56 months with the Columbia mental maturity scales, a vocabulary (AWST) and language comprehension test (LSVTA). RESULTS: Significant group differences were found in complications (pregnancy, birth, and neonatal), parity, and multiple birth rate. The AGA-GA group showed most satisfactory growth up to 56 months, with both the AGA-BW and SGA groups lagging behind. The AGA-GA group also scored significantly more highly on all developmental and cognitive tests than the other groups. Developmental test results were similar for the SGA and AGA-BW groups at five and 20 months, but AGA-BW infants (lowest gestation) had lower scores on performance intelligence quotient and language comprehension at 56 months than the SGA group. When prenatal and neonatal complications, parity, and multiple birth were accounted for, group differences in growth remained, but differences in cognitive outcome disappeared after five months. CONCLUSIONS: Being underweight and with a short gestation (SGA and VLBW) leads to poor weight gain and head growth in infancy but does not result in poorer growth than in infants of the same birth weight but shorter gestation (AGA-BW) in the long term. SGA is related to early developmental delay and later language problems; however, neonatal complications may have a larger detrimental effect on long term cognitive development of VLBW infants than whether they are born SGA or AGA.     

Anthropometric assessment of nutritional status in newborn infants. Discriminative value of mid arm circumference and of skinfold thickness

74 appropriate-for-gestational age (AGA) and 22 small-for-gestational age (SGA) caucasian infants were studied for anthropometric parameters: mid arm circumference (MAC), triceps and subscapular skinfold thickness (TSKF and SSKF) recorded at 15 and 60 s, chest circumference (cc), head circumference, birth weight and length.MAC is highly correlated with birth weight either in AGA (r = 0.936; P < 0.001) or in SGA infants (r = 0.860; P < 0.001). MAC is also correlated with gestational age in AGA (r = 0.850; P < 0.001) and SGA infants (r = 0.76; P < 0.001). Similar correlations were found between TSKF, SSKF and birth weight or gestational age. Arm muscle and fat areas are also positively correlated with birth weight and gestational age, in AGA and SGA infants.A multiple regression analysis of our data allowed a classification of the best discriminant anthropometric parameters between AGA and SGA infants. MAC, SSKF15, SSKF60 and chest circumference were selected. An equation was established in AGA infants with these four parameters giving a predictive gestational age: gestational age (weeks) = 1.216 MAC (cm)?3.588 SSKF15 (mm)+0.263 CC (cm) + 17.9.The ratio of predicted gestational age to the real gestational age was 1.0 ± 0.044 in AGA versus 0.896 ± 0.034 in SGA infants.Our data suggest that MAC and SSKF provide a simple measure of body composition of neonates and a useful tool for determining the degree of maturity of a newborn independent of birth weight.     

Blood pressure in the small-for-gestational age newborn

AIM: The aim of the paper is to verify the existence of an inverse correlation between birth weight and blood pressure (BP) in neonates, infants and adolescents. METHODS: BP was measured at 7 days, 3, 6, 9, 12 months and 7-18 years in 432 subjects born at term at the Department of Pediatrics, Obstetrics and Reproductive Medicine, University of Siena; 228 of these subjects were small for gestational age (SGA) and 204 appropriate for gestational age (AGA). For small babies, BP was measured with a DYNAMAP oscillometer which provides digital visualisation of systolic, diastolic and mean arterial pressure and heart rate. In older children, a mercury sphygmomanometer was used. Statistical analysis was carried out with SPSS 8.01 software using the Kolmogorov-Smirnov test for normality of populations. RESULTS: Statistical analysis did not reveal any significant differences between SGA and AGA subjects in the various age classes of the first 12 months of life. Significant correlation was found between 7 and 18 years with differences in the various age classes for systolic pressure. Subjects with normal birthweight had lower systolic and diastolic BP. SGA males had higher risk of high systolic and diastolic pressure, whereas SGA females were only at higher risk for elevated diastolic pressure. CONCLUSIONS: SGA subjects should be monitored for BP and life-style between 7 and 18 years to risk of cardiovascular disease.     

Fetal growth regulation and intrauterine growth retardation

Gestational age and neonatal anthropometric parameters are currently used to evaluate fetal growth and are predictive factors of perinatal and postnatal morbidity and mortality. We performed a retrospective analysis of neonatal anthropometric parameters (weight, vertex-heel length and head circumference) in 1,470 live preterm neonates born between 1997 and 2002 and a prospective analysis of the same parameters in 1,786 live newborns of both sexes born in 2001 and 2002, products of single 37-42 week uncomplicated pregnancies in healthy Spanish Caucasian mothers. A progressive increase in these parameters with gestational age and sexual dimorphism were observed from the 30th week of gestational age onwards, with statistically-significant differences (p<0.05) at 38-42 weeks of gestational age. An increase in weight and length values in relation to previous Spanish studies was also documented in preterm newborns. It is estimated that 10-15% of children born small for gestational age (SGA) do not experience catch-up growth by the age of 3 years and may have short stature in adulthood. Preliminary data of a cross-sectional study on spontaneous growth in boys and girls born SGA without postnatal catch-up growth show that their +2 SD values of height are similar to -2 SD values of our normal control population of children born with adequate weight and length for gestational age (AGE). However, weight +2 SD values are similar to mean values of control children born AGE. In summary, our data show sexual dimorphism in neonatal anthropometric growth parameters and that these parameters change with time and may be updated. In addition children born SGA without postnatal catch-up are shorter and have higher weight than age-, height- and sex-matched controls born AGE.