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      Subclassification of Small for Gestational Age Children with Persistent Short Stature: Growth Patterns and Response to GH Treatment

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          Aim: We determined whether subclassification of short small for gestational age (SGA) children according to birth anthropometrics could delineate different patterns in gestation, delivery, postnatal growth, response to growth hormone (GH) treatment and parental height. Methods: 201 short SGA children were divided into three groups, SGA<sub>L</sub>, SGA<sub>L+W</sub> and SGA<sub>L+W+HC</sub>, according to birth length (L), weight (W) and head circumference (HC) ≤–2.00 standard deviation score (SDS). Results: SGA<sub>L+W+HC</sub> children were born after the shortest gestational age and more often by caesarean section than SGA<sub>L</sub> children (36.3 vs. 38.1 weeks, 68.4 vs. 24.4%). SGA<sub>L+W</sub> children had an intermediate pattern and experienced most gestational hypertension (p = 0.01). At birth, SGA<sub>L+W+HC</sub> children were shorter than SGA<sub>L</sub> or SGA<sub>L+W</sub> (–4.12 vs. –2.67 and –3.72 SDS, p ≤ 0.001). During the first 3 years of life, SGA<sub>L+W+HC</sub> children exhibited an increased growth in height (0.98 SDS) and HC (1.28 SDS) than SGA<sub>L</sub> (height, –0.06 SDS; HC, –0.30 SDS) and SGA<sub>L+W</sub> (height, 0.62 SDS; HC, –0.31 SDS). However, HC SDS remained smaller for SGA<sub>L+W+HC</sub> than the other groups at age 3. The groups did not differ in growth response during GH treatment. SGA<sub>L</sub> children tended to have shorter parents and target height than SGA<sub>L+W+HC</sub> children. Conclusions: Our study shows that subclassification of short SGA children might be a useful method for investigating SGA children as the subgroups revealed a different gestation, delivery and postnatal growth pattern. Response to GH treatment was not different between the groups.

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          Most cited references 16

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          Intrauterine growth retardation and postnatal growth failure associated with deletion of the insulin-like growth factor I gene.

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            Adult height after long-term, continuous growth hormone (GH) treatment in short children born small for gestational age: results of a randomized, double-blind, dose-response GH trial.

            The GH dose-response effect of long-term continuous GH treatment on adult height (AH) was evaluated in 54 short children born small for gestational age (SGA) who were participating in a randomized, double-blind, dose-response trial. Patients were randomly and blindly assigned to treatment with either 3 IU (group A) or 6 IU (group B) GH/m(2).d ( approximately 0.033 or 0.067 mg/kg.d, respectively). The mean (+/-SD) birth length was -3.6 (1.4), the age at the start of the study was 8.1 (1.9) yr, and the height SD score (SDS) at the start of the study -3.0 (0.7). Seventeen of the 54 children were partially GH deficient (stimulated GH peak, 10-20 mU/liter). Fifteen non-GH-treated, non-GH-deficient, short children born SGA, with similar inclusion criteria, served as controls [mean (+/-SD) birth length, -3.3 (1.2); age at start, 7.8 (1.7) yr; height SDS at start, -2.6 (0.5)]. GH treatment resulted in an AH above -2 SDS in 85% of the children after a mean (+/-SD) GH treatment period of 7.8 (1.7) yr. The mean (SD) AH SDS was -1.1 (0.7) for group A and -0.9 (0.8) for group B, resulting from a mean (+/-SD) gain in height SDS of 1.8 (0.7) for group A and 2.1 (0.8) for group B. No significant differences between groups A and B were found for AH SDS (mean difference, 0.3 SDS; 95% confidence interval, -0.2, 0.6; P > 0.2) and gain in height SDS (mean difference, 0.3 SDS; 95% confidence interval, -0.1, 0.7; P > 0.1). When corrected for target height, the mean corrected AH SDS was -0.2 (0.8) for group A and -0.4 (0.9) for group B. The mean (+/-SD) AH SDS of the control group [-2.3 (0.7)] was significantly lower than that of the GH-treated group (P < 0.001). Multiple regression analysis indicated the following predictive variables for AH SDS: target height SDS, height SDS, and chronological age minus bone age (years) at the start of the study. GH dose had no significant effect. In conclusion, long-term continuous GH treatment in short children born SGA without signs of persistent catch-up growth leads to a normalization of AH, even with a GH dose of 3 IU/m(2).d ( approximately 0.033 mg/kg.d).
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              Intrauterine growth of live-born Caucasian infants at sea level: Standards obtained from measurements in 7 dimensions of infants born between 25 and 44 weeks


                Author and article information

                Horm Res Paediatr
                Hormone Research in Paediatrics
                S. Karger AG
                January 2008
                05 December 2007
                : 69
                : 2
                : 89-98
                aDepartment of Pediatrics, Division of Endocrinology, Erasmus MC-Sophia Children’s Hospital, and bDepartment of Epidemiology and Biostatistics, Erasmus MC, Rotterdam, The Netherlands
                111812 Horm Res 2008;69:89–98
                © 2007 S. Karger AG, Basel

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                Figures: 3, Tables: 3, References: 25, Pages: 10
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