Autistic spectrum disorder and the fragile X premutation

Fragile X syndrome (FXS) is the most common inherited cause of mental retardation. It is also one of the most common identifiable causes of Autism Spectrum Disorder (ASD). Carriers of FXS are often considered to be cognitively and behaviorally unaffected. However, we report here on six individuals in the premutation range who also have ASD. A comparison is made with five subjects in the premutation range who did not receive a diagnosis of ASD. The six individuals with ASD had a range of cognitive ability levels from no impairment to moderate retardation. Discussion includes the impact of molecular variables including lowered FMR1 protein and elevated FMR1 mRNA in addition to environmental factors leading to the complex neurodevelopmental disorder of ASD.     

Catch-up growth in 166 small-for- gestational age premature infants weighing less than 1,000 g at birth

Catch-up growth was studied in 166 children born with an extremely low birth weight (<1,000 g) and small-for-gestational age (SGA, <10th percentile birth weight for gestational age). Of these children 159 were followed up for between 4 and 18 years (median 9 years). Group A, SGA <10th percentile of Lubchenco curves only; group B, <10th percentile of Mamelle's curves but >5th percentile, and group C, <5th percentile of Mammelle's curves. Catch-up growth was considered to be achieved when height, weight, and head circumference (HC) reached -2 SD of French reference data and remained above this limit afterwards. Catch-up growth in height was achieved in 126/156 children or 81% (group A 88%; group B 84%; group C 74%), before 3 years of age in 100/127 (78%). Seven children below -2 SD received growth hormone (1 child who caught up was excluded from the results). Catch-up growth in weight was achieved in 126/159 children or 79% (group A 86%; group B 82%; group C 73%), before 3 years of age in 87/126 (69%). Catch-up growth in HC was achieved in 126/156 or 81% (group A 78%; group B 92%; group C 77%), before 3 years of age in 102/127 (80%). Overall catch-up growth was achieved for all three parameters in 65% of children, two of three parameters in 19%, and one of three parameters in 8%. Eleven children never caught up on any parameter. While weight is a lesser concern and HC is not liable to intervention, a greater number of short children might benefit from growth hormone therapy.     

Protective effect of keratinocyte growth factor against lung abnormalities associated with hyperoxia in prematurely born rats

We used a prematurely born rat/hyperoxia model of bronchopulmonary dysplasia (BPD) to test whether keratinocyte growth factor (KGF) treatment would protect against the development of several serious (cardio-)pulmonary complications of early life exposure to hyperoxia. KGF significantly protected against hyperoxic lethality (13-day survival rate = 50/64 (78%) for the O(2)-KGF vs. 29/66 (44%) for the O(2)-saline group, p < 0.001). Although KGF failed to protect against hyperoxic inhibition of normal postnatal alveoli formation and early pulmonary fibrosis, KGF consistently had a significant protective/preventive effect against the development of pulmonary hypertension during hyperoxia as reflected in comparative right ventricular hypertrophy: mean increase = +35% above normal for the O(2)-saline group vs. +3% for the O(2)-KGF premature rat group (p < 0.01).     

Insulin, insulin-like growth factors-I and -II and insulin-like growth factor binding protein-3 in newborn serum: association with normal fetal head growth and head circumference

The insulin-like growth factors (IGF) and their binding proteins (IGFBP) have been implicated in the regulation of fetal weight and length. The aim of our study was to determine the relationship between head circumference at birth and serum levels of IGF-I, IGF-II, IGFBP-3 and insulin in full-term appropriate-for-gestational age (AGA) infants. Serum samples were obtained from 77 singleton full-term neonates, 69 AGA and 8 small-for-gestational age (SGA). The AGA infants were divided into three groups by head circumference: Group 1: < or = 3rd percentile; Group 2: at 50th percentile; Group 3: > or = 97th percentile. Serum levels of IGF-I, IGF-II, IGFBP-3 and insulin were determined with commercial kits and immunometric methods. There were no statistically significant differences in mean serum levels of IGF-I, IGF-II and IGFBP-3 between the groups. A significantly higher mean serum insulin level was noted in the AGA infants with a head circumference > or = 97th percentile compared to those with a head circumference < or = 3rd percentile (4.6 +/- 0.3 vs 3.3 +/- 0.6 microU/ml; p = 0.04), and in AGA infants with a head circumference above the 50th percentile compared to those with a head circumference below the 50th percentile (4.4 +/- 0.4 vs 3.3 +/- 0.3 microU/ml; p = 0.01). AGA infants with a head circumference above or below the 50th percentile did not differ statistically in their mean IGF-II and IGFBP-3 serum level, while IGF-I differed statistically between the groups (18 +/- 2.7 vs 11.6 +/- 1.6 ng/ml, respectively; p = 0.045). Using univariate analysis, head circumference correlated positively with insulin (r = 0.29; p = 0.016) and with IGF-I (r = 0.26; p = 0.03). A stepwise multivariate linear regression analysis, however, did show statistically significant correlation of head circumference with birth weight (f = 36; p = 0.0001), and only marginally with birth length (f = 4.7; p = 0.06) and insulin (f = 3.4; p = 0.07). No correlations were found between head circumference and IGF-I, IGF-II or IGFBP-3. These data suggest that apart from genetic and nutritional factors, insulin may play a role in promoting intrauterine head growth, as reflected by head circumference at birth.     

Catch-up growth of head circumference of very low birth weight,small for gestational age preterm infants and mental development to adulthood

OBJECTIVE: To examine the influence of postnatal energy quotient (EQ, energy intake/kg body weight per day) on head circumference (HC) growth and mental development of very low birth weight (VLBW), small for gestational age (SGA, <10th percentile) preterm infants. STUDY DESIGN: SGA VLBW preterm infants (n = 46) with primarily symmetric intrauterine growth restriction were compared with 62 appropriate for gestational age (AGA) VLBW preterm infants and 73 term infants from the Bonn Longitudinal study. RESULTS: Twenty-seven of 46 (59%) of the SGA preterm infants showed complete HC catch-up growth by the age of 12 months, but mostly before 6 months after term (HC catch-up group). These infants had significantly higher mean EQs from day 2 to 10 than the group of 19 infants without HC catch-up (EQ, 95 vs 78). Mean EQs correlated significantly with developmental and intelligence quotients (DQ/IQ) from 18 months to 6 years. As adults, the HC of the HC catch-up group was not significantly different from that of the AGA preterm infants, the term infants, and their parents. The group without HC catch-up had smaller HC as adults. CONCLUSIONS: Our data suggest that early postnatal high-energy nutrient intake for SGA preterm infants is needed to promote HC catch-up growth and to prevent negative consequences of undernutrition.     

Empathy in children with autism and conduct disorder: group-specific profiles and developmental aspects

Background: A deficit in empathy is discussed to underlie difficulties in social interaction of children with autism spectrum disorder (ASD) and conduct disorder (CD). To date, no study has compared children with ASD and different subtypes of CD to describe disorder‐specific empathy profiles in clinical samples. Furthermore, little is known about age influences on the development of empathic skills. The aim of the current study was to compare cognitive and emotional empathy in different age groups of children with ASD, CD with elevated or low callous‐unemotional‐traits (CU+ vs. CU?) and a matched control group (CG). Methods: Fifty‐five boys with ASD, 36 boys with CD‐CU+, 34 boys with CD‐CU? and 67 controls were included. The study implemented three tasks on emotion recognition, perspective taking and emotional affection induced by another person’s situation. Multivariate Analysis of variance with the factors group and age (median split) including their interaction term was performed to describe disorder‐specific profiles. Results: Empathy profiles showed differential impairment in children with ASD and CD‐CU+. Boys with ASD were impaired in cognitive empathy while participants with CD‐CU+ were impaired in emotional empathy. Children with CD‐CU? did not differ from the CG. However, boys with CD‐CU? were less emotionally reactive in response to film stimuli than children with ASD. Furthermore, we found strong age effects indicating an increase in cognitive and affective empathic skills beyond early infancy in all groups. Conclusions: In this study, distinct empathic profiles in children with ASD and CD‐CU+ were found. Furthermore, the work demonstrates improvement of empathic skills throughout childhood and adolescence, which is comparable for individuals with psychiatric disorders and control children. These results yield implications for further research as well as for therapeutic interventions.     

Optimal outcome in individuals with a history of autism

Background: Although autism spectrum disorders (ASDs) are generally considered lifelong disabilities, literature suggests that a minority of individuals with an ASD will lose the diagnosis. However, the existence of this phenomenon, as well as its frequency and interpretation, is still controversial: were they misdiagnosed initially, is this a rare event, did they lose the full diagnosis, but still suffer significant social and communication impairments or did they lose all symptoms of ASD and function socially within the normal range? Methods: The present study documents a group of these optimal outcome individuals (OO group, n = 34) by comparing their functioning on standardized measures to age, sex, and nonverbal IQ matched individuals with high‐functioning autism (HFA group, n = 44) or typical development (TD group, n = 34). For this study, ‘optimal outcome’ requires losing all symptoms of ASD in addition to the diagnosis, and functioning within the nonautistic range of social interaction and communication. Domains explored include language, face recognition, socialization, communication, and autism symptoms. Results: Optimal outcome and TD groups’ mean scores did not differ on socialization, communication, face recognition, or most language subscales, although three OO individuals showed below‐average scores on face recognition. Early in their development, the OO group displayed milder symptoms than the HFA group in the social domain, but had equally severe difficulties with communication and repetitive behaviors. Conclusions: Although possible deficits in more subtle aspects of social interaction or cognition are not ruled out, the results substantiate the possibility of OO from autism spectrum disorders and demonstrate an overall level of functioning within normal limits for this group.     

Characteristics of autism spectrum disorder in Cornelia de Lange syndrome

Background: The prevalence of autism spectrum disorder (ASD) symptomatology is comparatively high in Cornelia de Lange syndrome (CdLS). However, the profile and developmental trajectories of these ASD characteristics are potentially different to those observed in individuals with idiopathic ASD. In this study we examine the ASD profile in CdLS in comparison to a matched group of individuals with ASD. Method: The Autism Diagnostic Observation Schedule (ADOS) was administered to 20 individuals with CdLS (mean age = 11.34; range = 6–13 years) and 20 individuals with idiopathic ASD (mean age = 10.42; range = 8–11 years). Participants were matched according to adaptive behaviour and receptive language skills. Results: Sixty‐five percent (N = 13) of individuals with CdLS met the cut‐off score for autism on the total ADOS score. Further analysis at domain and item level indicated that individuals with CdLS showed significantly less repetitive behaviour, (specifically sensory interests); more eye contact, more gestures and less stereotyped speech than the ASD group. The CdLS group also showed higher levels of anxiety. Conclusions: The comparison between CdLS and idiopathic ASD indicates subtle group differences in the profile of ASD symptomatology that are not accounted for by degree of intellectual disability or receptive language skills. These differences may not be evident when relying solely upon clinical and domain level scores, but may be distinguishing features of the ASD presentations in the two disorders. The findings have implications for the conceptualisation and assessment of ASD in individuals with genetic syndromes.     

Temperament and increased weight gain in infants

The role of temperamental characteristics in accelerated and decelerated weight gain in normal infants has not been investigated previously except for differences in activity. The present study drew a random sample of 200 normal infants from a largely middle-class private practice. It found 24 infants who gained 30 or more percentile points in weight for length determinations between 6 and 12 months of age and 25 who lost 20 percentile points or more. These growth data were compared with contemporaneous findings on the Infant Temperament Questionnaire. Those gaining the most had significantly more difficult temperament ratings (p less than 0.05) and were perceived by their mothers as "more difficult than average" (p less than 0.001). Infants with the most decelerated growth were not temperamentally different from the general sample. Negative mood rather than low activity was the specific characteristic distinguishing the infants gaining the most (p = 0.006). Clinical experience would suggest that fussy infants are fed more to quiet them.     

Growth and nutritional indexes in early life predict pulmonary function in cystic fibrosis

OBJECTIVE: To determine the relation of growth and nutritional status to pulmonary function in young children with cystic fibrosis (CF). STUDY DESIGN: The relation of weight-for-age (WFA), height-for-age (HFA), percent ideal body weight (%IBW), and signs of lung disease at age 3 years with pulmonary function at age 6 years was assessed in 931 patients with CF. Associations of changes in WFA from age 3 to 6 on pulmonary function were also assessed. RESULTS: WFA, HFA, and %IBW were poorly associated with lung disease at age 3 years, but all were strongly associated with pulmonary function at age 6 years. Those with WFA below the 5th percentile at age 3 had lower pulmonary function at age 6 compared with those above the 75th percentile (FEV(1): 86 +/- 20 [SD] versus 102 +/- 18 % predicted, respectively). Pulmonary function was highest in those whose WFA remained >10th percentile from age 3 to 6 (FEV(1): 100 +/- 19 % predicted) and lowest in those who remained <10th percentile (84 +/- 21 % predicted). Patients with signs and symptoms of lung disease at age 3 years had lower pulmonary function at age 6 years. CONCLUSIONS: Aggressive intervention early in life aimed at growth and nutrition and/or lung disease may affect pulmonary function.     

The Prader-Willi phenotype of fragile X syndrome

The Prader-Willi phenotype (PWP) of fragile X syndrome (FXS) is associated with obesity and hyperphagia similar to Prader-Willi syndrome (PWS), but without cytogenetic or methylation abnormalities at 15q11-13. Thirteen cases of PWP and FXS are reported here that were identified by obesity and hyperphagia. Delayed puberty was seen in 5 of 9 cases who had entered puberty, a small penis or testicles in seven of 13 cases, and infant hypotonia and/or a poor suck in seven of 13 cases. Autism spectrum disorder occurred in 10 of 13 cases, and autism was diagnosed in seven of 13 cases. We investigated cytoplasmic interacting FMR1 protein (CYFIP) expression, which is a protein that interacts with FMR1 protein (FMRP) because the gene for CYFIP is located at 15q11-13. CYFIP mRNA levels were significantly reduced in our patients with the PWP and FXS compared to individuals without FXS (p < .001) and also individuals with FXS without PWP (p = .03).     

Intact inner speech use in autism spectrum disorder: evidence from a short-term memory task

BACKGROUND: Inner speech has been linked to higher-order cognitive processes including 'theory of mind', self-awareness and executive functioning, all of which are impaired in autism spectrum disorder (ASD). Individuals with ASD, themselves, report a propensity for visual rather than verbal modes of thinking. This study explored the extent to which children with ASD used inner speech or visual imagery to support recall from short-term memory. METHOD: Twenty-five children with ASD and 20 comparison children with moderate learning disabilities completed an immediate serial recall task, in which stimuli consisted of items with either phonologically similar features, visuo-spatially similar features or control items which were neither visuo-spatially nor phonologically similar. RESULTS: ASD and comparison participants, with verbal mental ages above 7 years, recalled phonologically similar stimuli less well than control stimuli, indicating that both groups were using inner speech to recode visually presented information into a phonological code. In contrast, those participants with verbal mental ages below 7 years, whether with ASD or not, recalled visuo-spatially similar stimuli less well than control stimuli, indicating visual rather than phonological coding. This developmental pattern mirrors that found in typically developing children. CONCLUSIONS: Under experimental conditions, individuals with ASD use inner speech to the same extent as individuals without ASD of a comparable mental age.     

孤独症谱系障碍儿童体格生长状况的横断面调查

目的：探讨孤独症谱系障碍(ASD)儿童体格生长偏离状况。方法：本文数据来自于2016年1月至2019年8月在复旦大学附属儿科医院有资质的发育行为专科医生诊断的ASD专科病历数据库,采集在疑似（<2岁）和诊断ASD时常规体格测量等检查数据,疑似ASD的幼儿随访到2岁后诊断。体格测量结果依据WHO儿童体格参考标准转化为年龄相应的体重、身长/身高、BMI的Z值,用于体格生长状况评价。BMI Z值>+2 SD为肥胖、<-2 SD为消瘦,肥胖和消瘦统称为生长偏离。并行生长偏离影响因素分析。结果：ASD专科病历数据库511例连续样本进入本文分析, 1~4岁420例（82.2%）,~8岁91例（17.8%）;男431例,女80例。总体ASD人群及1~4岁肥胖比例高于消瘦,差异有统计学意义;~8岁ASD人群肥胖与消瘦比例差异无统计学意义;ASD男女童肥胖、消瘦比例差异无统计学意义。~8岁ASD人群生长偏离和消瘦发生率分别是1~4岁的3.3倍（95%CI: 1.81~6.00）和5.64倍（95%CI: 2.22~14.31）。总体和1~4岁ASD人群相比,体重、身长/身高和BMI的Z值分布曲线较WHO儿童参考标准Z值正态分布参考线右移,向肥胖偏离;~8岁ASD人群BMI的Z值分布曲线峰值低,体型匀称比例下降,向+2 SD和-2 SD外延伸,向肥胖、消瘦偏离。结论：ASD儿童人群生长偏离既有肥胖也有消瘦,ASD学龄期儿童人群生长偏离发生率高于学龄前期儿童人群,且体型匀称比例下降,向肥胖和消瘦偏离。     

Attention across modalities as a longitudinal predictor of early outcomes: the case of fragile X syndrome

Background: Fragile X syndrome (FXS) is an early diagnosed monogenic disorder, associated with a striking pattern of cognitive/attentional difficulties and a high risk of poor behavioural outcomes. FXS therefore represents an ideal model disorder to study prospectively the impact of early attention deficits on behaviour. Methods: Thirty‐seven boys with FXS aged 4–10 years and 74 typically developing (TD) boys took part. Study 1 was designed to assess visual and auditory attention at two time‐points, 1 year apart. Study 2 investigated attention to multimodal information. Both tested attention markers as longitudinal predictors of risk for poor behaviour in FXS. Results: Children with FXS attended less well than mental‐age matched TD boys and experienced greater difficulties with auditory compared to visual stimuli. In addition, unlike TD children, they did not benefit from multimodal information. Attention markers were significant predictors of later behavioural difficulties in boys with FXS. Conclusions: Findings demonstrate, for the first time, greater difficulties with auditory attention and atypical processing of multimodal information, in addition to pervasive global attentional difficulties in boys with FXS. Attention predicted outcomes longitudinally, underscoring the need to dissect what drives differing developmental trajectories for individual children within a seemingly homogeneous group.     

Feeling,caring, knowing: different types of empathy deficit in boys with psychopathic tendencies and autism spectrum disorder

Background: Empathy dysfunction is one of the hallmarks of psychopathy, but it is also sometimes thought to characterise autism spectrum disorders (ASD). Individuals with either condition can appear uncaring towards others. This study set out to compare and contrast directly boys with psychopathic tendencies and boys with ASD on tasks assessing aspects of affective empathy and cognitive perspective taking. The main aim of the study was to assess whether a distinct profile of empathy deficits would emerge for boys with psychopathic tendencies and ASD, and whether empathy deficits would be associated with conduct problems in general, rather than psychopathic tendencies or ASD specifically. Methods: Four groups of boys aged between 9 and 16 years (N = 96) were compared: 1) psychopathic tendencies, 2) ASD, 3) conduct problems and 4) comparison. Tasks were included to probe attribution of emotions to self, empathy for victims of aggression and cognitive perspective‐taking ability. Results: Boys with psychopathic tendencies had a profile consistent with dysfunctional affective empathy. They reported experiencing less fear and less empathy for victims of aggression than comparison boys. Their cognitive perspective‐taking abilities were not statistically significantly different from those of comparison boys. In contrast, boys with ASD had difficulties with tasks requiring cognitive perspective taking, but reported emotional experiences and victim empathy that were in line with comparison boys. Boys with conduct problems did not differ from comparison boys, suggesting that the affective empathy deficit seen in boys with psychopathic tendencies was specific to that group, rather than common to all boys with conduct problems. Conclusions: Although both groups can appear uncaring, our findings suggest that the affective/information processing correlates of psychopathic tendencies and ASD are quite different. Psychopathic tendencies are associated with difficulties in resonating with other people’s distress, whereas ASD is characterised by difficulties in knowing what other people think.     

The broader language phenotype of autism: a comparison with specific language impairment

BACKGROUND: Some individuals with autism spectrum disorders (ASD) experience linguistic difficulties similar to those found in individuals with specific language impairment (SLI). Whether these behaviours are indicative of a common underlying genetic cause or a superficial similarity is unclear. METHODS: Standardised language assessments were administered to three participant groups: parents of children with ASD (Par-A), parents of children with specific language/literacy impairment (Par-L) and parents of typically developing children (Par-T) (n = 30, in each group). Additionally, the Autism-Spectrum Quotient (AQ) was used to assess autism-like tendencies, in particular, social language use. RESULTS: The Par-A group performed better than the Par-L group (and identical to the Par-T group) on all language tests. Conversely, the Par-A group was characterised by higher levels of pragmatic difficulties than the other two groups, as measured by the communication subscale of the AQ. CONCLUSIONS: No evidence was found for a shared phenotype in parents of children with ASD and SLI. A model is presented describing the relation between SLI and ASD.     

Sonographic biometry of the frontal lobe in normal and growth-restricted neonates

Assessing the impact of restricted intrauterine growth on neonatal frontal lobe (FL) dimensions is important. We aimed to create a sonographic nomogram of FL dimensions in neonates at different gestational ages (GA) and evaluate the impact of small head circumference (HC) on FL dimensions. We conducted sonographic biometry of the FL at birth. We included 218 newborn infants born at GA of 24-43 wk: appropriate for GA and normal HC (n = 178), and small for GA and small HC (n = 23). Infants with a 5-min Apgar score <7, severe congenital malformations, or chromosomal abnormalities were excluded. Through a coronal ultrasound scan via the anterior fontanelle at the level where the most lateral point of the left Sylvian fissure was best demonstrated, we drew a triangle connecting the most lateral point of the Sylvian fissure, the corpus callosum, and the subcalvarian point of the interhemispheric fissure. We measured the three sides of the triangle, Sylvian-fontanellar distance, Sylvian-callosal distance, and fontanellar-callosal distance, and calculated the frontal triangular area. All four FL dimensions increased significantly between 24 and 43 wk of gestation in both appropriate for GA-normal HC and small for GA-small HC neonates, and were strongly correlated with HC and birth weight. Regression lines of GA against Sylvian-fontanellar distance, Sylvian-callosal distance, fontanellar-callosal distance, and frontal triangular area in the appropriate for GA-normal HC group differed significantly from those of the small for GA-small HC group (p < 0.05). Male neonates had significantly larger Sylvian-fontanellar and Sylvian-callosal distances than females (p < 0.01 and p < 0.015, respectively). In conclusion, FL measures increased significantly between 24 and 43 wk of gestation, and were strongly correlated with HC. We speculate that a sonographically small fetal HC implies growth restriction of the fetal FL.     

初产足月儿与经产足月儿宫内生长水平差异的研究

目的 制定不同胎龄初产足月儿与经产足月儿宫内生长百分位曲线,研究分娩产次对宫内生长潜力的影响。方法 采用整群取样法于2013年4月至2015年9月对深圳市两家医院出生的胎龄37~41周单胎足月儿进行体格生长现场测量。曲线拟合应用Lambda-Mu-Sigma（LMS）法。结果 获得了14 529例胎龄37~41周初产、经产足月儿各胎龄出生体重、身长、头围、胸围、顶臀长均值,并制定了其10th、25th、50th、75th、90th百分位曲线。经产足月儿上述5项指标的百分位曲线的形态和增长趋势与初产足月儿一致,但37~41周各胎龄经产足月儿上述5项指标的均值及百分位曲线值均高于初产足月儿。除胎龄41周组初产与经产组顶臀长比较差异无统计学意义外,其余各胎龄组5项指标均值比较差异均有统计学意义（P < 0.05）。结论 胎龄37~41周经产足月儿各胎龄体重、身长、头围、胸围、顶臀长5项指标宫内生长水平均高于初产足月儿,提示分娩产次是宫内生长潜力重要的影响因素。     

Growth charts for monitoring postnatal growth at NICU of extreme preterm-born infants

Aim: To provide growth charts for clinical monitoring of extra‐uterine growth from birth to full‐term age, in infants born before 26 weeks of gestation, hospitalized at neonatal intensive care unit (NICU), and compare it to the commonly used Swedish preterm birth‐size reference. Methods: This retrospective longitudinal cohort comprised all infants born before 26 + 0 weeks of gestation and surviving to full‐term age (n = 162), admitted to the NICU, Karolinska Hospital during the period January 1990 to December 2002. Body weight was recorded daily, head circumference (HC) weekly and length twice a month. Results: Birth weight (BW), length and HC showed a normal distribution without significant gender difference. The majority of the infants showed a pronounced postnatal growth restriction for all growth variables with increasing deviation from the reference with age. The mean initial weight loss was 16% with nadir at 6 days of age and a mean time to regain BW of 18 days. At discharge from NICU, 75% of those initially appropriate for gestational age infants were below –2 standard deviation scores for at least one of the body size variables. Conclusion: The poor extra‐uterine growth pattern points to the need of growth curves for extra‐uterine growth of extremely premature infants.     

Height and weight of 70 prenatally dystrophic children of ages 5 to 11

Growth-retarded, markedly slim children with poor appetite are often seen by a pediatric endocrine service without any previous information to their parents about known correlations between their condition and poor intrauterine growth. There are follow-up studies covering the first years of life, but only a few concerning growth prognosis in later years. Therefore, full-term, nonasphyxiated small-for-date children were traced by a questionnaire at ages between 5 to 11 years, and growth data were evaluated using standard deviation scores (x-means/s): for the whole group the height deficit was -0.724 +/- 0.965 SD, whereas normal persons show a deviation from normality of 0.000 +/- 1.000 SD (p less than 0.001); it was -0.823 +/- 0.949 SD and -0.495 +/- 0.927 SD for children with birth weights below and above the 3rd percentile for birth weight resp., and -1.285 +/- 1.031 and -1.261 +/- 1.069 SD for children whose length or length and weight were below the 3rd percentile at birth. The weight deficit (0.048 +/- 0.999 SD) of the whole group was statistically but not medically significant. There was no correlation to the parents or the mothers heights. These data correspond well with those from a review of the literature. Together with an accurate bone age determination our data could help to improve the counselling of involved families about growth prognosis of their originally small for date children.