宫内发育迟缓早产儿生后生长迟缓对早期神经发育的影响

目的 探讨宫内发育迟缓(IUGR)早产儿生后生长迟缓对早期神经发育的影响。方法 回顾性分析2008 年5 月至2012 年5 月出生并定期随访至校正胎龄6 个月的171例早产儿的临床资料,其中IUGR早产儿40 例,早产适于胎龄儿(AGA)131 例。比较两组校正胎龄40 周、3个月、6个月的生长迟缓率及校正胎龄3 个月、6 个月时的神经发育情况。神经发育采用Gesell发育量表评估。结果 IUGR 组校正胎龄40 周、3个月、6个月的生长迟缓率均明显高于AGA 组;校正胎龄3 个月时Gesell 各项发育商(大运动、精细动作、语言、适应性及个人社交)均低于AGA 组;校正胎龄6 个月时,IUGR组精细动作及语言发育商低于AGA组,但两组大运动、适应性及个人社交发育商比较差异已无统计学意义。IUGR组6月龄时体重追赶落后的患儿各项发育商均明显低于追赶理想的IUGR 和AGA 患儿。结论 IUGR早产儿生后早期的生长迟缓可对早期神经发育产生不良影响。     

Low birth weight and intrauterine growth retardation in Filipino infants

Low birth weight, prematurity, and intrauterine growth retardation represent important health tasks for neonates. Pregnancy outcome risk categories based on combinations of these variables and a measure of body proportions were developed and tested with respect to how well they predict poor growth during infancy. Data were collected during a prospective community-based survey of births representative of the Cebu region of the Philippines. In the sample of 2139 births for which there were available birth weight and gestational age data, 20% of infants were classified as growth retarded and 12% were low birth weight. Low birth weight, the more conservative category, was a better predictor of small infant size at 12 months of age than intrauterine growth retardation. Rohrer's index, which captures information about patterns of intrauterine growth, improves the positive predictive value of categories based either on intrauterine growth retardation or low birth weight. Infants who had an adequate Rohrer's index, ie, were well proportioned at birth, were smaller at 12 months of age than infants who had a low Rohrer's index, ie, had weight deficits relative to their lengths at birth. Important questions about the value of the intrauterine growth retardation classification are raised by the results.     

Postnatal growth failure in preterm infants: recovery of growth and body composition after term

BACKGROUND: Many preterm infants are significantly growth restricted at hospital discharge and are at increased risk for long-term growth failure. AIMS: To compare growth and weight gain composition after term between preterm infants who were growth retarded and those who were not. STUDY DESIGN: An observational longitudinal study was conducted. SUBJECTS: 35 preterm infants who showed growth retardation at term (group 1) and 26 preterm infants who did not (group 2). OUTCOME MEASURES: Growth and body composition were assessed at term and at 1, 2, 3, 4 and 5 months of corrected age. RESULTS: At term, and at 1, 2, and 3 months of corrected age, growth-retarded infants showed significantly lower body weight and fat mass than infants who did not develop growth retardation. The mean energy and protein intakes did not differ significantly between the two groups. Daily increases in body weight and fat mass between term and three months did not differ between the groups. However, during the fourth and fifth months, daily gains of body weight and fat mass were significantly greater in growth-retarded than in non-growth-retarded infants, and as a result, body weight and fat mass were comparable between the two groups at 4 and 5 months of corrected age. CONCLUSIONS: In terms of growth parameters and body composition, growth-retarded preterm infants recovered from postnatal growth failure within the fourth month of corrected age.     

Growth and development of term disproportionate small-for-gestational age infants at the age of 7 years

Twenty-four term infants with disproportionate intrauterine growth retardation (SGA group) and 24 normally grown term infants matched for age, sex, birth rank and social class were followed from birth until 7 years of age. Both groups were free from perinatal complications and chronic diseases. The children in the SGA group continued to be underweight-for-height with a low ponderal index and a relatively small head circumference at the age of 7 years. Only minor shifts occurred in the individual growth curves since the age of 3 years. In 12 SGA children and 1 control multiple 'soft' neurological signs were found. Their grammar school teachers observed problematic behavior (hyperactivity, poor concentration and clumsiness) in 9 and academic problems in 5 of the 12 SGA children with neurological dysfunction. These findings indicate that disproportionate intrauterine growth retardation at term can have long-term effects on growth and development.     

Twelve‐month neurodevelopmental outcome in preterm infants with and without intrauterine growth restriction

Aim: To evaluate the neurodevelopmental outcome at 12 months’ corrected age in preterm infants with and without severe intrauterine growth restriction. Methods: This prospective follow‐up study included 37 infants with severe intrauterine growth restriction and 36 appropriate‐for‐gestational‐age infants born between 26 and 34 weeks. Neonatal and infant data were prospectively recorded. Infants were assessed at 12 ± 2 months’ corrected age with the Hammersmith Infant Neurological Examination and the Bayley Scale for Infant Development version‐II. Results: Both groups were similar in demographic characteristics and perinatal status. No significant differences in neurodevelopmental performance were found. The mental development index was 98.8 (SD 9.0) vs 98.4 (SD 13.1) (p = 0.9) and the psychomotor development index was 91.7 (SD 9.9) vs 95.5 (SD 13.4) (p = 0.2) for the study and reference groups respectively. Neurological assessment showed no significant differences between the two groups. Conclusion: Although the study group showed a non‐significant trend towards a lower score in the psychomotor development index than the reference group, significant differences at 12 months could not be demonstrated. IUGR infants continued to have significantly lower weight, length and head circumference at 1 year.     

Heterogeneous growth and mental development of intrauterine growth-retarded infants during the first 3 years of life

Postnatal growth and development were studied in two groups of term infants with intrauterine growth retardation (IUGR) and one group of infants with normal birth weight up to 3 years of age (total sample, 205 infants). Infants with IUGR were classified as having low ponderal index (IUGR-LPI) or adequate ponderal index (IUGR-API). At birth, the two groups of infants with IUGR had similar birth weight, but length and head circumference measurements were significantly different. Overall, the IUGR-API infants remained lighter and shorter and had smaller head circumferences up to 30 months of age. The IUGR-LPI infants experienced catch-up growth in weight during the first months, because of greater fat deposition. At 24 months of age, the IUGR-API infants scored below the others on mental items. At 3 years of age the IUGR-API infants had the lowest values on seven of eight developmental measures and on the composite score; at these two time periods, the group with normal birth weight scored the highest, and the IUGR-LPI infants obtained intermediate values. It is concluded that infants with IUGR tend to follow postnatal growth and developmental patterns that are associated with their physical characteristics at birth.     

宫内发育迟缓儿脐血胰岛素样生长因子-1、胰岛素和生长激素水平测定及意义

目的：研究宫内发育迟缓(IUGR)的发生与脐血中胰岛素样生长因子-1（IGF-1）、胰岛素（INS）和生长激素（GH）的关系,以探讨内分泌环境对胎儿IUGR的影响。方法：选择新生儿63例（男37例,女26例）,根据出生体重分为IUGR组(n=33)和正常出生体重组(对照组,n=30)。测定并比较两组脐血中IGF-1、INS和GH的含量。结果：①IUGR组脐血中IGF-1和INS的水平均明显低于对照组, GH的水平明显高于对照组(P<0.05)。②相关分析显示出生体重与脐血中IGF-1水平呈正相关(r=0.625,P<0.01),与GH水平呈负相关(r=-0.257,P<0.05);胎龄与脐血中IGF-1水平呈正相关(r=0.271,P<0.05)。③多元线性逐步回归分析显示脐血IGF-1和INS水平是影响出生体重的重要因素。结论：内分泌环境调控胎儿的生长发育,脐血中的IGF-1和INS水平对胎儿体重有影响,IGF-1水平低下可能是导致IUGR 的原因之一。［中国当代儿科杂志,2010,12（10）：771-773］     

Altered growth, hypoglycemia, hypoalaninemia, and ketonemia in the young rat: postnatal consequences of intrauterine growth retardation

We characterized some of the consequences of intrauterine growth retardation in rat pups growth retarded [small for gestational age (SGA)] due to bilateral maternal uterine artery ligation. Pups of sham and nonoperated (normal) mothers served as controls. SGA pups had significantly reduced body and carcass mass throughout the study while body mass did not differ between sham and normal pups after 4 days. Brain mass was similar in the three groups at any age, while at 21 days and later, SGA liver weight as % body mass exceeded that of sham or normals. At 21 days, a 48-h fast reduced plasma glucose significantly in SGA compared to sham and normal pups; SGA plasma insulin was decreased and glucagon increased. Hepatic phosphoenolpyruvate carboxykinase activity and glycogen content were similar among groups. SGA pups did have significantly reduced plasma alanine and elevated betahydroxybutyrate levels. No differences in the responses to fasting occurred at 28 or 35 days. These data indicate that intrauterine growth retardation has profound effects on postnatal growth and metabolism.     

Early feeding advancement in very low-birth-weight infants with intrauterine growth retardation and increased umbilical artery resistance

BACKGROUND: To investigate whether intrauterine growth retardation (birth weight <10th percentile), increased umbilical artery resistance (resistance index >90th percentile measured by Doppler velocimetry), or brain sparing (increased umbilical artery resistance and decreased middle cerebral artery resistance index <5th percentile) were associated with early feeding intolerance in very low-birth-weight (VLBW, <1,500 g) infants. METHODS: From July 1999 to December 2000, 124 inborn VLBW infants were enrolled in a prospective trial evaluating early enteral nutrition after a standardized feeding protocol (daily feeding advancement, 16 mL/kg birth weight). Feeding tolerance was assessed as the age at which full enteral feeds (150 mL/kg daily) were achieved. Data are shown as median, 25th, and 75th percentiles. RESULTS: Full enteral feeds were achieved at 15 days (range, 12-21 days) of age for all infants. Intrauterine growth retardation (full enteral feeding achieved at 14 days; range, 12-21 days), increased umbilical artery resistance (full enteral feeding achieved at 14 days; range, 11-16 days), and brain sparing (full enteral feeding achieved at 15 days; range, 14-20 days) were not associated with early feeding intolerance. CONCLUSION: Very low-birth-weight infants with intrauterine growth retardation, increased umbilical artery resistance, and brain sparing tolerated enteral feeding as well as appropriate-for-gestational-age VLBW infants.     

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.     

Somatic growth in infant heart transplant recipients

Infant heart transplantation is now entering its second decade of clinical experience. To understand better issues relating to somatic growth, this retrospective study will describe growth patterns in a group of infant heart transplant recipients. Early growth: growth velocity from birth to transplantation in 77 infants transplanted before 6 months of age was compared with growth velocity from transplant to 3 months. Growth from 3 to 6 months and from 6 to 12 months after transplantation is described. Growth velocities (mean +/- SD) for weight (g/d) and length (cm/yr) for these 4 time periods respectively were: 7+/-14 and 27+/-22, 32+/-9 and 35+/-14, 17+/-7 and 24+/-10, 12+/-6 and 17+/-8. Growth velocities for both weight (p<0.01) and length (p = 0.04) were significantly improved in the first 3 months after transplantation. Late growth: Growth beyond 5 yr post-transplantation was described in a group of 51 infants transplanted in the first year of life and who survived at least 5 yr (median 6.8 yr, range 5.0 to 10.9). Most recent growth parameters (z-score; mean +/- SD) were: weight -0.55+/-1.2, height -0.48+/-0.97 and weight for height -0.16+/-0.96. Factors (with significant p-values) evaluated for their possible influence on late height (<5th percentile vs. > or =5th percentile) were: age at transplant, hospital days from transplant to discharge, hospital days 1st year after transplantation (p = 0.019), hospital days after 1st year, rejection episodes 1st year, rejection episodes 1-5 yr (p = 0.02) mid-parental height (p = 0.008) and isotopic glomerular filtration rate (p = 0.055). Conclusion: Growth while awaiting infant heart transplantation is poor, but adequate catch-up growth does occur. Beyond 5 yr most (88%) infant heart transplant recipients have weight and height in the normal range. Early illness, late rejection and genetic growth potential may play the largest role in later height attainment.     

Development of visual evoked potentials following intrauterine growth retardation.

Visual evoked potentials to flash (FVEP) were recorded in 23 symmetrically growth retarded newborns of between 32 and 39 weeks gestational age and 41 normally grown controls. At 9 months post term FVEP recordings were repeated in 14 of the growth retarded and 26 of the control infants. The development of two long latency negative components of the wave form of the neonatal FVEP was delayed in the growth retarded infants. The amplitude of a long latency negative peak in the 9 month post term FVEP was reduced in the growth retarded infants. We suggest that intrauterine growth retardation may affect the development of secondary activity in the visual cortex.     

宫内发育迟缓与胰岛素样生长因子及其结合蛋白的关系

目的 检测宫内发育迟缓(IUGR)儿脐血胰岛素样生长因子-1(IGF-1)、胰岛素样生长因子结合蛋白-3(IGFBP-3)水平,分析这些指标的变化程度与胎儿期生长的关系。方法 将86例脐血标本分为IUGR(即小于胎龄儿)组和适于胎龄儿(AGA)组。采用竞争性放射免疫分析法(RIA)测定IGF-1水平,非竞争性免疫放射分析法测定IGFBP-3水平。两组间比较用t检验,两变量之间的关系采用相关回归分析。结果 与AGA组相比,IUGR组脐血IGF-1和IGFBP-3水平显著降低(P均<0.01);IGF-1、IGFBP-3均随胎龄及出生体重增加而增加(P均<0.01);IGFBP-3与IGF-1呈正相关(P<0.01)。结论 脐血IGF-1和IGFBP-3的含量可作为判断新生儿生长发育程度的一项客观生化指标。     

Treatment of children with Down syndrome and growth retardation with recombinant human growth hormone.

The effect of recombinant human growth hormone on children with Down syndrome who had growth retardation and microcephaly was examined. Thirteen children with trisomy 21 without congenital heart disease who were short for age (-1.19 to -3.5 standard deviation score) and microcephalic (-1.58 to -6.60 standard deviation score) were given recombinant human growth hormone, 0.1 mg/kg subcutaneously, 3 days a week for 1 year. Before treatment, peak serum growth hormone concentrations were less than 10 micrograms/L after levodopa and clonidine stimulation tests in five patients, after clonidine in three patients, and after levodopa in three patients. Three patients had nocturnal integrated growth hormone concentrations of 0.5, 1.5 and 0.65 micrograms/L, respectively. The mean growth rate before treatment was 5.4 +/- 1.6 cm/yr and increased to 12.2 +/- 3.2 cm/yr (p less than 0.001) after 12 months of recombinant human growth hormone treatment. The mean head circumference standard deviation score before treatment was -3.1 +/- 1.3 and increased to -2.3 +/- 1.2 (p less than 0.001) at 12 months. Bone age before and 1 year after treatment increased in correspondence with chronologic age. Plasma hemoglobin A1c concentration was normal during treatment with recombinant human growth hormone. The mean plasma concentrations of insulin-like growth factor I at baseline and at 12 months were 0.54 +/- 0.19 U/ml and 1.25 +/- 0.97 U/ml, respectively (p less than 0.02). We conclude that recombinant human growth hormone therapy can result in a significant increase in annual growth rate and head circumference in children with Down syndrome, without significant side effects.     

Minimal enteral feeding, fetal blood flow pulsatility, and postnatal intestinal permeability in preterm infants with intrauterine growth retardation

OBJECTIVE: To study the effect of minimal enteral feeding (MEF) on intestinal permeability and feeding tolerance in preterm infants with intrauterine growth retardation (gestational age < 37 weeks, birth weight for gestational age p < 10). Furthermore, to determine whether fetal blood flow pulsatility or intestinal permeability predict feeding tolerance in these infants. DESIGN: Randomised controlled trial. METHODS: Within 48 hours of birth, infants were randomised to MEF or no enteral feeding (NEF) for five days in addition to parenteral feeding. Intestinal permeability was measured by the sugar absorption test before (SAT1) and after (SAT2) the study. The sugar absorption test measured the urinary lactulose/mannitol (LM) ratio after oral ingestion of a solution (375 mosm) containing mannitol and lactulose. Charts of all infants were assessed for measures of feeding tolerance. Fetal blood flow pulsatility index (U/C ratio) was measured within the seven days before birth. RESULTS: Of the 56 infants enrolled, 42 completed the study: 20 received MEF and 22 NEF. The decrease in LM ratio (LM ratio 1 - LM ratio 2) was not significantly different between the two groups (0.25 v 0.11; p = 0.14). Feeding tolerance, growth, and incidence of necrotising enterocolitis were not significantly different between the two groups. Neither the U/C nor the LM ratio 1 predicted feeding tolerance. CONCLUSIONS: The results suggest that MEF of preterm infants with intrauterine growth retardation has no effect on the decrease in intestinal permeability after birth. Neither fetal blood flow pulsatility nor intestinal permeability predicts feeding tolerance.     

早期营养干预对宫内生长迟缓大鼠胰岛素样生长因子和小肠发育及生长追赶的影响

目的　探讨早期营养干预对宫内生长迟缓 (IUGR)幼鼠血清胰岛素样生长因子 (IGF)和小肠发育及生长追赶的影响。方法　将 2 4只IUGR新生雌鼠和 8只正常新生雌鼠随机分为 4组 :IUGR模型组 ,IUGR低蛋白组 ,IUGR高蛋白组 ,正常对照组。于生后 4周时检测各组大鼠血清IGF1、胰岛素样生长因子结合蛋白 3(IGFBP3)浓度、体重、身长和小肠重量、长度及肠黏膜组织结构变化。结果　 4周时IUGR高蛋白组血IGF1、IGFBP3和小肠黏膜绒毛高度、吸收表面积均显著高于对照组和IUGR模型组 (P <0 .0 5或P <0 .0 1) ;小肠重量、长度和体重、身长与对照组比较无显著性差异 (P均 >0 .0 5 )。结论　生后头 4周予高蛋白饮食早期营养干预IUGR幼鼠 ,可通过促进小肠发育达到满意的体格生长追赶。血清IGF1是反映生长追赶的灵敏指标     

Early bisphosphonate treatment in infants with severe osteogenesis imperfecta

OBJECTIVE: To evaluate prospectively the efficacy of bisphosphonate treatment in infants with severe forms of osteogenesis imperfecta (OI). STUDY DESIGN: Of 10 children (6 females) with OI type III, 5 (group A) started treatment (2 mg/kg neridronate administered intravenously for 2 consecutive days, every 3 months) just after diagnosis at birth and 5 (group B) after 6 months. Ten untreated children, matched for sex, age, and clinical severity of OI, constituted a historical control group (group C). We measured weight, length, and number of fractures every 3 months and serum and urinary levels of calcium, phosphorus, creatinine, serum alkaline phosphatase, 25-hydroxyvitamin D, insulin-like growth factor I, parathyroid hormone, and osteocalcin, urinary type I collagen N-terminal telopeptide, and lateral radiography of vertebral column every 6 months. RESULTS: Group A had better growth and a lower incidence of fractures than groups B and C in the first 6 months of treatment. In the second 6 months, both groups A and B had lower fracture rates than group C. After 12 months of therapy, osteocalcin and insulin-like growth factor I levels significantly increased only in group A. The urinary Ca/Cr ratio and N-terminal telopeptide/Cr ratio significantly declined only in treated patients. Vertebral body area and the structure of vertebral bodies improved in all treated patients, but especially in group A. CONCLUSIONS: Cyclical neridronate treatment, started just after diagnosis at birth, had positive effects on growth and fracture rate.     

早产儿出院后追赶生长的随访观察及宫外发育迟缓的影响因素

目的 研究早产儿纠正月龄6个月内追赶生长的情况,并分析宫外发育迟缓（EUGR）的影响因素。方法 选取在新生儿重症监护病房治疗后出院的,并建立序贯化定期随访档案且有完整随访记录的早产儿321例,按2015年“早产儿保健工作规范”出院后分组随访标准分为低危早产儿组（n=69）和高危早产儿组（n=252）。采用Z评分法对体重、身长和头围进行评估,分析早产儿纠正月龄6个月内追赶生长情况。并采用多因素logistic回归分析探讨6月龄EUGR发生的危险因素。结果 低危组和高危组两组早产儿体重、身长和头围的Z值 < -2（未达追赶生长）的百分比均随纠正月龄增加而逐渐下降,其中低危组早产儿纠正月龄6个月时体重、身长和头围未达追赶生长的比例分别降为1.4%（1/69）、2.9%（2/69）和 1.4%（1/69）,高危组早产儿相应的比例为1.2%（3/252）、1.6%（4/252）和3.6%（9/252）。高危组纠正6月龄EUGR发生率高于低危组（28.2% vs 15.9%,P=0.039）。多因素logistic回归分析显示,早产儿纠正6月龄EUGR的危险因素包括多胎（OR=2.68,P=0.010）、出生体重较低（<1 000 g：OR=14.84,P < 0.001;1 000~1 499 g：OR=2.85,P=0.005）、宫内发育迟缓（OR=11.41,P < 0.001）,而出生后营养强化可降低EUGR的风险（OR=0.25,P < 0.001）。结论 早产儿多可在纠正月龄6个月内达追赶生长;高危早产儿6月龄EUGR发生率较高;多胎、低出生体重、宫内发育迟缓为早产儿EUGR的危险因素,而出生后合理营养强化可降低早产儿EUGR的发生。     

Is intrauterine growth retardation a risk factor for child abuse?

A case-control study was conducted to determine whether infants with intrauterine growth retardation are at an increased risk of child abuse. Case children were those who had been born at Yale-New Haven Hospital and were reported to the hospital's child abuse committee because they had been physically abused. For each case, one control child was chosen from the hospital's log of births and matched to the case child by age, gender, race of the mother, method of payment for the hospitalization, and the provider of the child's health care at the time of birth. Infants were defined as having intrauterine growth retardation if they had either a ponderal index or a birth weight that was less than the tenth percentile for gestational age using the Kansas City or Denver growth standards. We identified 117 case-control pairs that met those criteria. The matched odds ratios for each of the four definitions of intrauterine growth retardation were less than one, indicating that infants with intrauterine growth retardation are at a decreased risk of abuse. The matched odds ratio for a low ponderal index according to the Kansas City standard was 0.4 (95% confidence interval 0.19, 0.83). This result was not affected by such possible confounding factors as the mother's age. We conclude that infants with intrauterine growth retardation are not at an increased risk and may be at a decreased risk of physical abuse.     

Catch up growth and pancreatic function in growth retarded neonates.

To test the hypothesis that relative pancreatic dysfunction is a determinant of catch up growth in small for gestational age (SGA) babies, 47 such babies (median gestation 38 weeks; range 27-41) and 41 appropriate for gestational age (AGA) babies matched for sex, race, and gestational age were recruited. Anthropometry was performed within 48 hours of birth and at 6 months. Faecal chymotrypsin activities were measured at 0-2 days, 14 days, 6 weeks and 6 months. At 6 months 30 SGA infants and 25 AGA infants were remeasured. In each group, median stool chymotrypsin activities doubled between 0-2 days and 6 months (9.0-25.5 IU/g SGA group; 11.6-25.3 IU/g AGA group). SGA babies had significantly lower chymotrypsin activities at 14 days (10.9 U/g) than AGA babies (15.5 U/g). In the SGA group faecal chymotrypsin activities at 0-2 days were strongly correlated with both catch up weight and with catch up length when corrected for the effects of birthweight. These data show that impaired pancreatic exocrine function at birth is associated with severe intrauterine malnutrition and with impaired catch up growth during the first 6 months of life.