The Indian Journal of Pediatrics

, Volume 73, Issue 1, pp 73–78

Small for gestation and growth hormone therapy

Symposium on Growth and Its Disorders — II

Abstract

3 to 10% of neonates are born small for gestation (SGA). This usually occurs because of intrauterine growth retardation (IUGR). After birth most SGA infants show good catch-up growth and normalize their height and weight. About 10% of them continue to remain short (<−2SD) and do not achieve normal adult, height, resulting in psychosocial problems. The mechanism of short stature in these children is poorly understood. Infants who do not show catch-up growth usually have an alteration in the GH-IGF-I axis. Diagnostic and management criteria for short stature in SGA were ill-defined in the past. Growth hormone (GH) therapy for improving height in these children has been approved by the FDA. GH therapy leads to growth acceleration and normalization of height during childhood. Long term GH treatment normalizes adult height above-2 SDS in 85% children, and 98% achieve an adult height within their target height range. GH therapy is safe in SGA children, but it is important to monitor for side effects.

Key words

Growth hormone Short stature Small for gestational age 

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References

  1. 1.
    Hediger ML, Overpeck MD, Maurer KRet al. Growth of infants and young children born small or large for gestational age: findings from the Third National Health and Nutrition Examination Survey.Arch Pediatr Adolesc Med 1998; 52: 1225–1231.Google Scholar
  2. 2.
    Chakraborty R, Roy M, Das SR. Proportion with low birth weight infants in an Indian population and its relationship with maternal age and parity.Hum Hered 1975; 25: 73–79.PubMedCrossRefGoogle Scholar
  3. 3.
    Singer DB, Sung CJ, Wigglesworth JS. Fetal growth and maturation: with standards for body and organ development. In Wigglesworth JS, Singer DB, eds.Textbook of Fetal and Perinatal Pathology. Boston; Blackwell Scientific Publications, 1996: 11–47.Google Scholar
  4. 4.
    Doctor BA, O'Riordan MA, Kirchner HLet al. Perinatal correlates and neonatal outcomes of small for gestational age infants born at term gestation.Am J Obstet Gynecol 2001; 185: 652–659.PubMedCrossRefGoogle Scholar
  5. 5.
    Ling PA, Abell DA, Beischer NA. Fetal growth retardation and preeclampsia.Br J Obstet Gynaecol 1980; 87: 13–18.Google Scholar
  6. 6.
    Ananth CV, Peedicayil A, Savitz DA. Effect of hypertensive diseases in pregnancy on birthweight, gestational duration, and small-for-gestational-age births.Epidemiology 1995; 6: 391–395.PubMedCrossRefGoogle Scholar
  7. 7.
    Mitchell EA, Thompson JM, Robinson Eet al. Smoking, nicotine and tar and risk of small for gestational age babies.Acta Paediatr 2002; 91: 323–328.PubMedCrossRefGoogle Scholar
  8. 8.
    Wright JT, Waterson EJ, Barrison IGet al. Alcohol consumption, pregnancy, and low birthweight.Lancet 1986; 93: 663–665.Google Scholar
  9. 9.
    Narang A, Chaudhuri MK, Kumar P. Small for gestational age babies: Indian scene.Indian J Pediatr 1997; 64: 221–224.PubMedGoogle Scholar
  10. 10.
    Gluckman PD. Clinical review 68: The endocrine regulation of fetal growth in late gestation: the role of insulin-like growth factors.J Clin Endocrinol Metab 1995; 80: 1047–1050.PubMedCrossRefGoogle Scholar
  11. 11.
    Le Roith D. Seminars in medicine of the Beth Israel Deaconess Medical Center. Insulin-like growth factors.N Engl J Med 1997; 336: 633–640.PubMedCrossRefGoogle Scholar
  12. 12.
    Giudice LC, de Zegher F, Gargosky SEet al. Insulin-like growth factors and their binding proteins in the term and preterm human fetus and neonate with normal and extremes of intrauterine growth.J Clin Endocrinol Metab 1995; 80: 1548–1555.PubMedCrossRefGoogle Scholar
  13. 13.
    Ozkan H, Aydin A, Demir Net al. Associations of IGF-I, IGFBP-I and IGFBP-3 on intrauterine growth and early catchup growth.Biol Neonate 1999; 76: 274–282.PubMedCrossRefGoogle Scholar
  14. 14.
    Harigaya A, Nagashima K, Nako Y, Morikawa A. Relationship between concentration of serum leptin and fetal growth.J Clin Endocrinol Metab 1997; 82: 3281–3284.PubMedCrossRefGoogle Scholar
  15. 15.
    Koistinen HA, Koivisto VA, Andersson S, Karonen SL, Kontula K, Oksanen L, Teramo KA. Leptin concentration in cord blood correlates with intrauterine growth.J Clin Endocrinol Metab 1997; 82: 3328–3330.PubMedCrossRefGoogle Scholar
  16. 16.
    Hediger MI, Overpeck MD, Maurer KR, Kuczmanski RJ, McGlynn A, Davis WW. Growth of infants and young children born small or large for gestational age: findings from the third national health and nutrition examination survey.Arch Pediatr Adolesc Med 1998; 152: 1225–1231.PubMedGoogle Scholar
  17. 17.
    Karlberg J, Albertsson-Wikland K. Growth in full-term small-for-gestational-age infants: from birth to final height.Pediatr Res 1995; 38: 733–739.PubMedCrossRefGoogle Scholar
  18. 18.
    Hokken-Koelega ACS, de Ridder MAJ, van Lemmen RJ, den Hartog H, de Munick Keizer-Schrama SMPF, Drop SLS. Children born small for gestational age: do they catch-up?Pediatr Res 1995; 38: 267–271.PubMedCrossRefGoogle Scholar
  19. 19.
    Veening MA, van Weissenbruch MM, Roord JJ, de Delemarre-van Waal HA. Pubertal development in children born small for gestational age.J Pediatr Endocrinol Metab 2004; 17: 1497–1505.PubMedGoogle Scholar
  20. 20.
    Hofman L, Cutfield WS, Robinson EMet al. Insulin resistance in short children with intrauterine growth retardation.J Clin Endocrinol Metab 1997; 82: 402–406.PubMedCrossRefGoogle Scholar
  21. 21.
    Law CM, Shiell AW. Is blood pressure inversely related to birth weight? The strength of evidence from a systematic review of the literature.J Hypertens 1996; 14: 935–941.PubMedCrossRefGoogle Scholar
  22. 22.
    Bhargava SK, Sachdev HS, Fall CH, Osmond C, Lakshmy R, Barker DJ, Biswas SK, Ramji S, Prabhakaran D, Reddy KS. Relation of serial changes in childhood body-mass index to impaired glucose tolerance in young adulthood.N Engl J Med 2004; 350: 865–875.PubMedCrossRefGoogle Scholar
  23. 23.
    Arends NJ, Boonstra VH, Duivenvoorden HJ, Hofman PL, Cutfield WS, Hokken-Koelega AC. Reduced insulin sensitivity and the presence of cardiovascular risk factors in short prepubertal children born small for gestational age (SGA).Clin Endocrinol (Oxf) 2005; 62: 44–50.CrossRefGoogle Scholar
  24. 24.
    Phipps K, Barker DJ, Hales CNet al. Fetal growth and impaired glucose tolerance in men and women.Diabetologia 1993; 36: 225–228.PubMedCrossRefGoogle Scholar
  25. 25.
    Barker DJP, Hales CN, Fall CHDet al. Type 2 (noninsulin-dependent) diabetes mellitus, hypertension and hyperlipidaemia (syndrome X): relation to reduced fetal growth.Diabetologia 1993; 36: 62–67.PubMedCrossRefGoogle Scholar
  26. 26.
    Barker DJ. Fetal origins of coronary heart disease.Br Med J 1995; 311: 171–174.Google Scholar
  27. 27.
    Fall CH, Vijayakumar M, Barker DJ, Osmond C, Duggleby S. Weight in infancy and prevalence of coronary heart disease in adult life.Br Med J 1995; 310: 17–19.Google Scholar
  28. 28.
    Hattersley AT, Tooke JE. The fetal insulin hypothesis: an alternative explanation of the association of low birthweight with diabetes and vascular disease.Lancet 1999; 353: 1789–1792.PubMedCrossRefGoogle Scholar
  29. 29.
    Rochiccioli P, Tauber M, Moisan V, Pienkowski C. Investigation of growth hormone secretion in patients with intrauterine growth retardation.Acta Paediatr Scand Suppl 1989; 349: 42–46.PubMedGoogle Scholar
  30. 30.
    de Waal WJ, Hokken-Koelega ACS, Stijnen T, de Muinck Keizer-Schrama SMPF, Drop SLS, and the Dutch Working Group on Growth Hormone. Endogenous and stimulated GH secretion, urinary GH excretion, and plasma IGF-I and IGF-II levels in prepubertal children with short stature after intrauterine growth retardation.Clin Endocrinol 1994; 41: 621–630.Google Scholar
  31. 31.
    Boguszewski M, Rosberg S, Albertsson-Wikland K. Spontaneous 24-hour growth hormone profiles in prepubertal small for gestational age children.J Clin Endocrinol Metab 1995; 80: 2599–2606.PubMedCrossRefGoogle Scholar
  32. 32.
    Ackland FM, Stanhope R, Eyre C, Hamill G, Jones J, Preece MA. Physiological growth hormone secretion in children with short stature and intra-uterine growth retardation.Horm Res 1988; 30: 241–245.PubMedGoogle Scholar
  33. 33.
    Stanhope R, Ackland F, Hamill Get al. Physiological growth hormone secretion and response to growth hormone treatment in children with short stature and intrauterine growth retardation.Acta Paediatr Scand 1989; 349: 47–52.Google Scholar
  34. 34.
    Leger J, Noel M, Limal JM, Czernichow P. Growth factors and intrauterine growth retardation. II. Serum growth hormone, insulin-like growth factor (IGF) I, and IGF-binding protein 3 levels in children with intrauterine growth retardation compared with normal control subjects: prospective study from birth to two years of age. Study Group of IUGR.Pediatr Res 1996; 40: 101–107.PubMedCrossRefGoogle Scholar
  35. 35.
    de Zegher F, Du Caju MV, Heinrichs Cet al. Early, discontinuous, high dose growth hormone treatment to normalize height and weight of short children born small for gestational age: results over 6 years.J Clin Endocrinol Metab 1999; 84: 1558–1561.PubMedCrossRefGoogle Scholar
  36. 36.
    Sas T, de Waal W, Mulder Pet al. Growth hormone treatment in children with short stature born small for gestational age: 5-year results of a randomized, double-blind, dose-response trial.J Clin Endocrinol Metab 1999; 84: 3064–3070.PubMedCrossRefGoogle Scholar
  37. 37.
    Van Pareren Y, Mulder P, Houdijk M, Jansen M, Reeser M, Hokken-Koelega A. 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.J Clin Endocrinol Metab 2003; 88: 3584–3590.PubMedCrossRefGoogle Scholar
  38. 38.
    Carel JC, Chatelain P, Rochiccioli P, Chaussain J. Improvement in adult height after growth hormone treatment in adolescents with short stature born small for gestational age: Results of a randomized controlled study.J Clin Endocrinol Metab 2003; 88: 1587–1593.PubMedCrossRefGoogle Scholar
  39. 39.
    de Zegher F, Wikland KA, Hartmut A, Chatelain P, Chaussain J, Lofstrom A, Jonsson B, Rosenfeld R. Growth hormone treatment of short children born small for gestational age: Growth responses with Continuous and Discontinuous regimens over 6 years.J Clin Endocrinol Metab 2000; 85(8): 2816–21; 88: 3584–3590.PubMedCrossRefGoogle Scholar
  40. 40.
    Sas T, Mulder P, Hokken-Koelega A. Body composition, blood pressure, and lipid metabolism before and during long-term growth hormone (GH) treatment in children with short stature born small for gestational age either with or without GH deficiency.J Clin Endocrinol Metab 2000; 85: 3786–3792.PubMedCrossRefGoogle Scholar
  41. 41.
    Leger J, Garel C, Fjellestad-Paulsen Aet al. Human growth hormone treatment of short-stature children born small for gestational age: effect on muscle and adipose tissue mass during a 3-year treatment period and after 1 year's withdrawal.J Clin Endocrinol Metab 1998; 83: 3512–3516.PubMedCrossRefGoogle Scholar
  42. 42.
    Sas TC, Gerver WJ, De Bruin Ret al. Body proportions during 6 years of GH treatment in children with short stature born small for gestational age participating in a randomised, double-blind, dose-response trial.Clin Endocrinol (Oxf) 2000; 53: 675–681.CrossRefGoogle Scholar
  43. 43.
    Sas T, Mulder P, Aanstoot HJet al. Carbohydrate metabolism during long-term growth hormone treatment in children with short stature born small for gestational age.Clin Endocrinol (Oxf) 2001; 54: 243–251.CrossRefGoogle Scholar

Copyright information

© Dr. K C Chaudhuri Foundation 2006

Authors and Affiliations

  1. 1.Centre for Child HealthSir Ganga Ram HospitalNew DelhiIndia
  2. 2.East New Delhi

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