Longitudinal growth trajectories and predictive risk factors for short stature in extremely preterm infants up to six years of age.

Persistent short stature, other potential outcomes, and the effect of growth hormone treatment in children who are born small for gestational age.

To understand the growth and development status and differences between small for gestational age (SGA) and appropriate for gestational age (AGA) preterm infants during corrected ages 0-24 months, and to provide a basis for early health interventions for preterm infants. A retrospective study was conducted, selecting 824 preterm infants who received regular health care at the Guangzhou Women and Children's Medical Center from July 2019 to July 2022, including 144 SGA and 680 AGA infants. The growth data of SGA and AGA groups at birth and corrected ages 0-24 months were analyzed and compared. The SGA group had significantly lower weight and length than the AGA group at corrected ages 0-18 months (P<0.05), while there were no significant differences between the two groups at corrected age 24 months (P>0.05). At corrected age 24 months, 85% (34/40) of SGA and 79% (74/94) of AGA preterm infants achieved catch-up growth. Stratified analysis by gestational age showed that there were significant differences in weight and length at corrected ages 0-9 months between the SGA subgroup with gestational age <34 weeks and the AGA subgroups with gestational age <34 weeks and 34 weeks (P<0.05). In addition, the weight and length of the SGA subgroup with gestational age 34 weeks showed significant differences compared to the AGA subgroups with gestational age <34 weeks and 34 weeks at corrected ages 0-18 months and corrected ages 0-12 months, respectively (P<0.05). Catch-up growth for SGA infants with gestational age <34 weeks and 34 weeks mainly occurred at corrected ages 0-12 months and corrected ages 0-18 months, respectively. SGA infants exhibit delayed early-life physical growth compared to AGA infants, but can achieve a higher proportion of catch-up growth by corrected age 24 months than AGA infants. Catch-up growth can be achieved earlier in SGA infants with a gestational age of <34 weeks compared to those with 34 weeks.

Very few data are available on longitudinal renal growth in small for gestational age (SGA) infants born at term. The aim of this prospective study was to estimate comparatively the renal growth in SGA infants and in infants born appropriate for gestational age (AGA) during the first 2 years of life. The study comprised groups of SGA and AGA infants with a gestational age (GA) of 36-41 weeks. The SGA group was classified into two subgroups of symmetrical and asymmetrical neonates according to the ponderal index. Serial renal ultrasonography (US) was performed at the ages of 41 weeks corrected age [GA (in weeks) plus age after birth (in weeks)] and at 3, 6, 12 and 24 months of chronological age and kidney length (KL) was related to other anthropometric indices. A total of 312 infants participated in the study out of which 197 were SGA, and a total number of 802 measurements were performed. The symmetrical SGA infants and, to a lesser degree, the asymmetrical SGA infants had smaller kidneys at birth compared with the AGA infants (P < 0.0001 and P < 0.001, respectively). The symmetrical SGA infants had a lower body weight (BW) (P < 0.001, P < 0.01) and crown-heel length (CHL) (P < 0.01, P < 0.05) than controls at the ages of 12 and 24 months of chronological age. The asymmetrical SGA infants had a lower BW (P < 0.01, P < 0.05) than controls at the ages of 12 and 24 months of chronological age. On the contrary, the KL in both SGA groups was not different from that of the AGA infants after the 41st week of corrected age and up to the 2nd year of life. SGA term infants had shorter KL at birth compared with AGA infants but a similar length from the 3rd to the 24th month of life. Early catch-up kidney growth was observed in both SGA groups and is more prominent in the symmetrical SGA infants. This observation may represent either an accelerated renal maturation process or early compensatory kidney hypertrophy in this group of infants.

Previous growth studies on children born small for gestational age (SGA) indicate that birth length, weight, and target height are important predictors for postnatal catch-up growth in SGA. Their influences on different phases of catch-up growth are still not described. The aim of this study was to clarify the influences of target height, length, and nutritional status at birth on different phases of postnatal catch-up growth (infancy, childhood, puberty) in SGA and the long-term consequences. Data were obtained from a longitudinal population-based growth study on Swedish children (N = 2815). Primary outcome measurements include heights, the changes in height standard deviation scores (SDS) during various phases of growth and relative risk for adult shortness. The difference in final height in children born SGA was attributable to their difference in target height and the magnitude of catch-up growth during the first 6 months of life, rather than the difference in length or body mass index (BMI) at birth. Length at birth showed negative influence on catch-up growth during infancy (0 to 2 years of age), but no significant influence thereafter. The BMI or weight for length SDS at birth showed no significant influence on catch-up growth during any growth phase. Target height showed positive influence on catch-up growth from the onset of childhood. Neither target height nor length and BMI at birth showed any significant influence on catch-up growth during puberty. The magnitude of catch-up growth during infancy, especially the first 6 months of life, is most critical in decreasing risk at adult shortness. We confirmed that the SGA group had a sevenfold greater risk for adult shortness than the non-SGA group (relative risk = 7.31; 95% confidence interval: 3.96-13.52). However, approximately 40% of children who were below -2 in height SDS at 2 years of age remained short at final height in both SGA and non-SGA groups. The mean height SDS of children born SGA increased by 1.65 from birth to final height, but the length deficit in centimeters at birth (-5.4 cm) persisted into adulthood (-5.9 cm). BMI at birth is not related to postnatal catch-up growth in infants born SGA, but birth length and target height are important. The genetic influence on catch-up growth appears to start from the onset of childhood. Being born short or becoming short during the first 2 years of life is similar in terms of risk for adult short stature.

This month’s contribution by Dr. Battaglia draws attention to the importance of both birthweight and gestational age in determining neonatal morbidity and mortality. It is hard to imagine the language of neonatology without the terms SGA, AGA, and LGA (small, appropriate, and large for gestational age), but prior to 1967 it was unusual to combine birthweight with gestational age. As Dr. Battaglia points out, small babies were considered to have been born prematurely. It is also interesting to note the mortality statistics in that era. The figures in the original article from Colorado subsequently were revised in a chart that detailed birthweight/gestational age categories by 250 g/1 week groups. (1) 1. ↵ Lubchenco LO, Searle DJ, Brazie JF. Neonatal mortality rate: relationship to birth weight and gestational age. J Pediatr. 1972;81:814–822 [OpenUrl][1][CrossRef][2][PubMed][3][Web of Science][4] # Classification by Birthweight and Gestational Age {#article-title-2} Small for gestational age (SGA), a term that has become widely used and occasionally misused, originated in the 1960s. At that time, neonatal intensive care units (ICUs) were called “premature nurseries” because it was assumed that all babies admitted to those units were preterm infants. Consideration of the small baby born at term or even postterm had led to the use of the term “placental insufficiency syndrome,” but scant attention had been paid to the heterogeneous population that was cared for in “premature nurseries” at that time. Some years earlier, my colleagues and I at Johns Hopkins, Dr Hellegers and Dr Frazier, had published an article examining the outcome of teenage pregnancies. (1) That study alerted us to the fact that clinical problems could be missed with specific study restrictions. For example, if teenage pregnancies included 16- to 19-year-old women, the perinatal mortality rate was not increased compared with women ages 20 to 29 years. Pregnancies in the 16- to 19-year-old group were far more frequent than in girls younger than 15 years of age and masked the high perinatal mortality rate of the latter group. This prompted us … [1]: {openurl}?query=rft.jtitle%253DThe%2BJournal%2Bof%2Bpediatrics%26rft.stitle%253DJ%2BPediatr%26rft.aulast%253DLubchenco%26rft.auinit1%253DL.%2BO.%26rft.volume%253D81%26rft.issue%253D4%26rft.spage%253D814%26rft.epage%253D822%26rft.atitle%253DNeonatal%2Bmortality%2Brate%253A%2Brelationship%2Bto%2Bbirth%2Bweight%2Band%2Bgestational%2Bage.%26rft_id%253Dinfo%253Adoi%252F10.1016%252FS0022-3476%252872%252980114-8%26rft_id%253Dinfo%253Apmid%252F5074362%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/external-ref?access_num=10.1016/S0022-3476(72)80114-8&link_type=DOI [3]: /lookup/external-ref?access_num=5074362&link_type=MED&atom=%2Fneoreviews%2F4%2F4%2Fe91.atom [4]: /lookup/external-ref?access_num=A1972N589700027&link_type=ISI

ObjectiveThis study aims to identify the risk factors associated with short stature in children born small for gestational age (SGA) at full-term.MethodsThis was a retrospective study. The subjects were full-term SGA infants who were followed up until the age of 2 years. The risk factors for short stature were identified with univariate and multivariate analyses.ResultsOf 456 full-term SGA children enrolled in this study, 28 cases had short stature at 2 years of age. A significant decrease in placental perfusion was found in the short children group with intravoxel incoherent motion (IVIM) technology, which was an advanced bi-exponential diffusion-weighted imaging (DWI) model of magnetic resonance imaging (MRI) (p = 0.012). Compared to non-short children born SGA at full-term, the short children group underwent an incomplete catch-up growth. Mothers who suffered from systemic lupus erythematosus were more likely to have a short child born SGA (p = 0.023). The morbidity of giant placental chorioangioma was higher in the short children group. The pulsatility index (PI), resistivity index (RI), and systolic-diastolic (S/D) ratio of umbilical artery were higher in the short children group than in the non-short control group (p = 0.042, 0.041, and 0.043). Multivariate analysis demonstrated that decrease of perfusion fraction (fp) in IVIM of placental MRI, chromosomal abnormalities, short parental height, and absence of catch-up growth were associated with a higher risk of short stature in children born SGA at full-term.ConclusionRisk factors for short stature in full-term SGA children at 2 years of age included a decrease of perfusion fraction fp in IVIM of placental MRI, chromosomal abnormalities, and short parental height.

To assess eye movements and binocular function in 14-year-olds with very low birthweight (VLBW: birthweight </= 1500 g) and 14-year-olds born at term but small for gestational age (SGA: birthweight < 10th percentile) in a population-based study. Ophthalmological examinations including measurements of heterophoria/tropia, near point of convergence, accommodative amplitude, stereopsis, nystagmus, saccades and smooth pursuit were performed in 51 adolescents with VLBW, 58 adolescents born SGA and in a control group consisting of 75 subjects of the same age. Latent or manifest strabismus, poor stereopsis, poor convergence and nystagmus were all more frequent in the VLBW group than in the control group. The VLBW group did not differ from the control group regarding accommodative amplitude or saccades and smooth pursuit. The SGA population did not differ from the control group in the measured variables. Premature birth with VLBW affects binocular visual functions negatively in adolescence, whereas birth small for date at term does not appear to be a risk factor for impaired eye movements and binocular function.

Background: Neonatal period is the most vulnerable for Small for Gestational Age (SGA) new-borns for survival.About 60% of the new-borns who born term but have low birth weight due to fetal growth restriction termed as Small for Gestational Age (SGA). The burden of SGA newborn is very high in countries of low and middle income and is concentrated high in South Asia. Identifying these low-birth-weight SGA newborns and referring them to higher centers for effective interventions would help in decreasing neonatal mortality and morbidity. Among the anthropometric measurements, birth weight is the single gold standard for identification SGA but assessment of accurate BW in rural areas where weight machine and trained personnel are not available specially in home deliveries, other simple and easier anthropometric measurement of the newborn may be as important. Foot length is a screening tool that may be simple but accurate to identify small new-born in need of extra care in rural settings of developing country like Bangladesh. Neonatal foot length (FL) has been proposed as a stable and reliable alternative, as it is less affected by intrauterine growth restriction (IUGR). Objective: To compare mean foot length in term Appropriate for Gestational Age (AGA) and SGA newborns, to assess the correlation between foot length and gestational age in both groups and to determine if foot length can help to differentiate between AGA and SGA infants when GA is uncertain. Methods: This cross-sectional, analytical study was conducted in the Department of Anatomy, Rangpur Medical College, Rangpur from July 2020 to June 2021 on 200 newborns of both sexes with gestational age between 37 and 42 weeks. The newborn was selected and measured within 24 hours of birth. 100 term newborns weighted&lt;2.5 kg regarAded as SGA were the case and another 100-term newborns weighted&gt;2.5 kg regarded as AGA served as control. The birth weight, foot length were measured and a comparison was done between AGA and SGA newborns. Data was analyzed by using a statistical package for social sciences (SPSS version 26). Result: The mean± SD of birth weight in AGA and SGA groups was 2.99±0.31kg and 2.10±0.24kg respectively, it was observed that the mean±SD of foot length in AGA group was 8.41±0.74cm and was 7.17±0.81cm in SGA group. Both BW and foot length was significantly higher in AGA group than SGA group. Again, foot length was significantly correlated with birth weight in both AGA and SGA groups. Conclusion: Foot length of SGA newborns are as effective as birth weight measurement to predict birth weight in SGA newborns Keywords: Appropriate for gestational age (AGA), Small for gestational age (SGA), Birth weight (BW), Foot length (FL). J Rang Med Col. 2025 Sep;10(2): 55-59

Background: Various studies have shown an association between low birth weight and the prevalence of elevated blood pressure later in life. However, a relationship between birth weight and blood pressure in the neonatal period has not been investigated yet. Objective: To study the relationship between birth weight and blood pressure during the first week of life. Methods: Systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial blood pressure (MBP) were measured every 8 h during days 1, 2, 3, 4 and 7 in 44 small for gestational age (SGA) infants and compared with those of infants born with a birth weight appropriate for gestational age (AGA). The infants were matched for gestational age and gender. Results: Meanbirth weight (range) in the SGA group was 778 (460–1,400) g versus 1,524 (960–2,730) g in the AGA group, and mean (range) gestational age of both groups was 30.5 (27.3–35.5) weeks. In the first week of life, SGA and AGA infants had similar SBP, DBP and MBP. Also, after adjustment for confounders (maternal medication, smoking), SBP, DBP and MBP rose equally in SGA and AGA infants during the first week of life. AGA infants showed a positive correlation between birth weight and blood pressure, but SGA infants showed an inverse correlation. Conclusions: Although differences in blood pressure were found between SGA and AGA infants in the first week of life, the inverse relationship between birth weight and blood pressure in SGA infants warrants follow-up studies to investigate a possible link with late cardiovascular disease.

Objective To explore the clinical characteristics of small for gestational age (SGA) infants and appropriate for gestational age (AGA) infants among late preterm infants, and to provide a clinical basis for improving the management quality of premature infants during the perinatal period. Methods From November 2014 to November 2015, a total of 688 late preterm infants who were discharged from Department of Neonatology, West China Second University Hospital, Sichuan University, were chosen as study subjects. According to gestational age and birth weight, 151 SGA preterm infants were included in SGA group, 537 AGA preterm infants were included in AGA group. The clinical medical records of preterm infants were analyzed retrospectively. The general clinical data, common complications and maternal pregnancy complications between two groups of preterm infants were compared statistically. Results ①The birth weight of SGA group was lower than that of AGA group, and the duration of hospital stay was longer than that of AGA group, and the differences were statistically significant(P<0.05). There were also significant differences between two groups of preterm infants in constituent ratio of gender and delivery modes (cesarean section or eutocia) (P<0.05). ②The incidence rate of respiratory distress syndrome (RDS) of SGA group was lower than that of AGA group, while the incidence rates of alimentary tract hemorrhage, necrotizing enterocolitis (NEC) and hypoglycemia were higher than those of AGA group, and the differences were were statistically significant (P<0.05). ③The incidence rates of hypertensive disorder complicating pregnancy, multiple pregnancy and eclampsia of SGA group of maternal were higher than those of AGA group, while the incidence rate of premature rupture of fetal membranes was lower than that of AGA group, and the differences were statistically significant (P<0.05). ④For caesarean section delivery, there were no significant differences between mothers using and without using glucocorticoids before childbirth in the incidence rates of RDS for both SGA and AGA preterm infants. Conclusions There were more perinatal complications and longer length of stays of SGA preterm infants than AGA preterm infants. Therefore, the management and follow-up of SGA among late preterm infants should be strengthened to improve their quality of life. Key words: Infant, small for gestational age; Perinatal care; Appropriate for gestational age; Infant, premature

To investigate the factors influencing the occurrence of small for gestational age (SGA) at different degrees and provide a basis for early identification of severe SGA cases. Neonatal and maternal prenatal information were retrospectively collected from January 2018 to December 2022 at Peking University People's Hospital. The neonates were divided into three groups: severe SGA group (birth weight below the 3rd percentile for gestational age and sex), mild SGA group (birth weight ≥3rd percentile and <10th percentile), and non-SGA group (birth weight ≥10th percentile). An ordered multinomial logistic regression model was used to analyze the factors influencing the occurrence of SGA at different degrees. A total of 14 821 neonates were included, including 258 cases (1.74%) in the severe SGA group, 902 cases (6.09%) in the mild SGA group, and 13 661 cases (92.17%) in the non-SGA group. The proportions of preterm births and stillbirths were higher in the severe SGA group compared to the mild SGA and non-SGA groups (P<0.0125). The proportion of neonatal asphyxia was higher in both the severe SGA and mild SGA groups compared to the non-SGA group (P<0.0125). Ordered multinomial logistic regression analysis showed that maternal pre-pregnancy underweight (OR=1.838), maternal pre-pregnancy obesity (OR=3.024), in vitro fertilization-embryo transfer (OR=2.649), preeclampsia (OR=1.743), connective tissue disease during pregnancy (OR=1.795), nuchal cord (OR=1.213), oligohydramnios (OR=1.848), and intrauterine growth restriction (OR=27.691) were all associated with a higher risk of severe SGA (P<0.05). Maternal parity as a multipara (OR=0.457) was associated with a lower likelihood of severe SGA (P<0.05). Maternal pre-pregnancy underweight, maternal pre-pregnancy obesity, in vitro fertilization-embryo transfer, preeclampsia, connective tissue disease during pregnancy, oligohydramnios, nuchal cord, and intrauterine growth restriction are closely related to the occurrence of more severe SGA. Maternal parity as a multipara acts as a protective factor against the occurrence of severe SGA.

Background: The burden of having small for gestational age (SGA) children is high in low- and middle-income countries, mainly in South Asia. Identifying these low birth weight and SGA infants and referring them to higher centers for effective intervention will help reduce neonatal mortality and morbidity. Anthropometric measurements of the neonatal population, especially birth weight measurements, constitute an important scientific research tool for studying the determinants and consequences of impaired or excessive fetal growth. Objective: To find an alternative anthropometric procedure, the present study was done to measure and compare birth weight with crown heel length (CHL), head circumference (HC), and mid-upper arm circumference (MUAC) as predictors of birth weight in small for gestational age (SGA). Methods: This cross-sectional, analytical study was done in the Department of Anatomy, Rangpur Medical College, Rangpur from July 2020 to June 2021 on 200 newborns of both sexes with gestational age between 37 and 42 weeks. The newborn was selected and measured within 24 hours of birth. 100 term newborns weighted &lt;2.5 kg regarded as SGA were the subjects of the study. Another 100-term newborns weighted &gt;2.5 kg regarded as AGA served as control. The birth weight, head circumference, mid-upper arm circumference, and crown heel length were measured and a comparison of all the variables was done between AGA and SGA newborns. Data was analyzed by using a statistical package for social sciences (SPSS version 26). Result: The mean± SD of birth weight in AGA and SGA groups was 2.99 ±0.31 and 2.10±0.24 respectively; it was observed that the mean± SD of crown heel length, head circumference, and mid-upper arm circumference and Ponderal index in AGA group was significantly higher than SGA group; however the MAC/HC ratio was almost similar between AGA and SGA groups. All the above variables were significantly correlated with birth weight in both AGA and SGA groups. Conclusion: Some simple and inexpensive measurements of newborns especially the head circumference of SGA newborns are as effective as birth weight measurement; crown heel length, and mid-upper arm circumference could also be used to predict birth weight in SGA newborns. J Rang Med Col. September 2023; Vol. 8, No. 2: 14-19

To investigate the difference in quality of life (QOL) between small for gestational age (SGA) and appropriate for gestational age (AGA) infants during early childhood, and to investigate the factors influcing the QOL. The Infant and Toddler Quality of Life Questionnaire-47 (ITQOL-SF47) was used to investigate the QOL of 1 to 3-year-old children born SGA and AGA who visited the child health care division. QOL was compared between SGA (n=203) and AGA groups (n=130), between the catch-up (n=119) and no-catch-up subgroups (n=84) of children born SGA, and between the single healthcare (n=144) and multiple healthcare subgroups (n=59) of children born SGA. The generalized linear model was used to investigate the factors influencing the QOL. The total ITQOL score of the SGA group was significantly lower than that of the AGA group (630±99 vs 716±84; P<0.05). In children born SGA, the no-catch-up subgroup had a significantly lower total ITQOL score than the catch-up subgroup (602±96 vs 649±97; P<0.05), and the single healthcare subgroup had a significantly lower total ITQOL score than the multiple healthcare subgroup (616±94 vs 657±107; P<0.05). The generalized linear model analysis showed that in children born SGA who had catch-up or multiple healthcare visits, who were female or living in the Chongqing urban area, or their mothers had a higher educational levels had higher total ITQOL score. SGA infants have lower QOL than AGA infats during their early childhood. Proper promotion of catch-up growth and regular healthcare visits will contribute to the improvement of the QOL of SGA infants. The QOL of SGA infants is also influcenced by children's sex, residence and the degree of mothers' educational levels.

Purpose: The aim of this study was to evaluate the relationship between thyroid hormone levels and clinical outcomes in preterm, small for gestational age (SGA) infants. Materials and Methods: The premature newborns (gestational age of ≤30 weeks) were divided into two groups as SGA and non-SGA. Thyroid stimulating hormone (TSH) and free thyroxine (fT4) levels, the frequency of congenital hypothyroidism (CH), demographic and clinical characteristics, morbidity and mortality rate were compared between the groups. Results: A total of 430 premature newborns, 72 in the SGA group and 358 in the non-SGA group were included. The frequency of CH, morbidity, demographic and clinical characteristics were similar between two groups. The mortality rate was higher in SGA (36.1%) than in non-SGA group (13.6%). Serum fT4 level was lower in SGA group (1.04±0.30 ng/dl) compared to the non-SGA group (1.24±0.33 ng/dl). The serum TSH level was higher in SGA group (9.91 ± 5.6 uIU/L) than in non-SGA group (6.6 ± 5.2 uIU/L). Conclusion: The frequency of thyroid dysfunction was higher in preterm SGA infants compared to non-SGA, which was due to transiently high TSH and low fT4 concentrations. Therefore, thyroid function tests should be monitored periodically in preterm and SGA infants.

According to the classification system used, 15-60% of stillbirths remain unexplained, despite undergoing recommended autopsy examination, with variable attribution of fetal growth restriction (FGR) as a cause of death. Distinguishing small-for-gestational age (SGA) from pathological FGR is a challenge at postmortem examination. This study uses data from a large, well-characterized series of intrauterine death autopsies to investigate the effects of secondary changes such as fetal maceration, intrauterine retention and postmortem interval on body weight. Autopsy findings from intrauterine death investigations (2005-2013 inclusive, from Great Ormond Street Hospital and St George's Hospital, London) were collated into a research database. Growth charts published by the World Health Organization were used to determine normal expected weight centiles for fetuses born ≥ 24 weeks' gestation, and the effects of intrauterine retention (maceration) and postmortem interval were calculated. There were 1064 intrauterine deaths, including 533 stillbirths ≥ 24 weeks' gestation with a recorded birth weight. Of these, 192 (36%) had an unadjusted birth weight below the 10th centile and were defined as SGA. The majority (86%) of stillborn SGA fetuses demonstrated some degree of maceration, indicating a significant period of intrauterine retention after death. A significantly greater proportion of macerated fetuses were present in the SGA population compared with the non-SGA population (P = 0.01). There was a significant relationship between increasing intrauterine retention interval and both more severe maceration and reduction in birth weight (P < 0.0001 for both), with an average artifactual reduction in birth weight of around -0.8 SD of expected weight. There was an average 12% reduction in fetal weight between delivery and autopsy and, as postmortem interval increased, fetal weight loss increased (P = 0.0001). Based on birth weight alone, 36% of stillbirths are classified as SGA. However, fetuses lose weight in utero with increasing intrauterine retention and continue to lose weight between delivery and autopsy, resulting in erroneous overestimation of FGR. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.