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Growth and body composition in very young SGA children

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Abstract

Infants with a very low birth weight are at risk of a reduced number of nephrons predisposing to kidney disorder, hypertension, and metabolic syndrome. Approximately 3% of infants are born small for gestational age (SGA), defined as birth weight and/or length at least 2 SD below the mean for gestational age (GA), independently of whether these children are born prematurely or at term. About 10% of these children do not show postnatal catch-up growth and remain of short stature during childhood. Most of these infants are not growth hormone (GH)-deficient, but may have GH resistance. Although GH-resistant, the majority of patients benefit from GH therapy, normalize height during childhood, maintain a normal growth velocity during puberty, and attain a normal adult height. To date, GH has been shown to be safe and no significant adverse effects have been demonstrated. Children with congenital chronic kidney disease (CKD) are born with subnormal birth weight and length and about 25% are born SGA. Shortness and need for GH treatment is highly correlated with weight at birth and gestational age. Primary renal disorders modify the response to GH treatment. Analysis of whether SGA is an additional risk factor for CKD regarding the development of hypertension, metabolic syndrome and cardiovascular complications is required.

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References

  1. Clayton PE, Cianfarani S, Czernichow P, Johannsson G, Rapaport R, Rogol A (2007) Consensus statement: management of the child born small for gestational age through to adulthood: a consensus statement of the International Societies of Pediatric Endocrinology and the Growth Hormone Research Society. J Clin Endocrinol Metab 92:804–810

    Article  CAS  PubMed  Google Scholar 

  2. Lee PA, Chernausek SD, Hokken-Koelega AC, Czernichow P (2001) International Small for Gestational Age Advisory Board consensus development conference statement: management of the short child born small for gestational age. Pediatrics 111:1253–1261

    Article  Google Scholar 

  3. Karlberg J, Albertsson-Wikland K (1995) Growth in full term small for gestational age infants: from birth to final height. Pediatr Res 38:733–739

    Article  CAS  PubMed  Google Scholar 

  4. Hokken-Koelega AC, De Ridder MA, Lemmen RJ, Den Hartog H, De Muinck Keizer-Schrama SM, Drop SL (1995) Children born small for gestational age: do they catch up? Pediatr Res 38:267–271

    Article  CAS  PubMed  Google Scholar 

  5. Rapaport R, Tuvemo T (2005) Growth and growth hormone in children born small for gestational age. Acta Paediatr 94:1348–1355

    Article  PubMed  Google Scholar 

  6. Karlberg J, Luo ZC (2000) Foetal size to final height. Acta Paediatr 89:632–636

    Article  CAS  PubMed  Google Scholar 

  7. Cianfarani S, Ladaki C, Geremia C (2006) Hormonal regulation of postnatal growth in children born small for gestational age. Horm Res 65:70–74

    Article  CAS  PubMed  Google Scholar 

  8. Cianfarani S, Germani D, Rossi P, Rossi L, Germani A, Ossicini C, Zuppa A, Argirò G, Holly JM, Branca F (1998) Intrauterine growth retardation: evidence for the activation of the insulin-like growth factor (IGF)-related growth-promoting machinery and the presence of a cation-independent IGF binding protein-3 proteolytic activity by two months of life. Pediatr Res 44:374–380

    Article  CAS  PubMed  Google Scholar 

  9. De Waal WJ, Hokken-Koelega AC, Stijnen T, de Muinck Keizer-Schrama SM, Drop SL (1994) 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. The Dutch Working Group on Growth Hormone. Clin Endocrinol (Oxf) 41:621–630

    Article  Google Scholar 

  10. Thieriot-Prevost G, Boccara JF, Francoual C, Badoual J, Job JC (1988) Serum insulin-like growth factor 1 and serum growth-promoting activity during the first postnatal year in infants with intrauterine growth retardation. Pediatr Res 24:380–383

    Article  CAS  PubMed  Google Scholar 

  11. Abuzzahab MJ, Schneider A, Goddard A, Grigorescu F, Lautier C, Keller E, Kiess W, Klammt J, Kratzsch J, Osgood D, Pfäffle R, Raile K, Seidel B, Smith RJ, Chernausek SD (2003) IGF-I receptor mutations resulting in intrauterine and postnatal growth retardation. N Engl J Med 349:2211–2222

    Article  CAS  PubMed  Google Scholar 

  12. Barrios V, Buño M, Pozo J, Muñoz MT, Argente J (2000) Insulin-like growth factor-binding protein-2 levels in pediatric patients with growth hormone deficiency, eating disorders and acute lymphoblastic leukemia. Horm Res 53:221–227

    Article  CAS  PubMed  Google Scholar 

  13. Cianfarani S, Geremia C, Scott CD, Germani D (2002) Growth, IGF system, and cortisol in children with intrauterine growth retardation: is catch-up growth affected by reprogramming of the hypothalamic-pituitary-adrenal axis? Pediatr Res 51:94–99

    Article  CAS  PubMed  Google Scholar 

  14. Klammt J, Pfäffle R, Werner H, Kiess W (2008) IGF signaling defects as causes of growth failure and IUGR. Trends Endocrinol Metab 19:197–205

    Article  CAS  PubMed  Google Scholar 

  15. Coutinho DC, Coletta RR, Costa EM, Pachi PR, Boguszewski MC, Damiani D, Mendonca BB, Arnhold IJ, Jorge AA (2007) Polymorphisms identified in the upstream core polyadenylation signal of IGF1 gene exon 6 do not cause pre- and postnatal growth impairment. J Clin Endocrinol Metab 92:4889–4892

    Article  CAS  PubMed  Google Scholar 

  16. Ester WA, van Meurs JB, Arends NJ, Uitterlinden AG, de Ridder MA, Hokken-Koelega AC (2009) The −G1245A IGF1 polymorphism is related with small head size and less brain sparing in small for gestational age born children. Eur J Endocrinol 160:549–555

    Article  CAS  PubMed  Google Scholar 

  17. Cianfarani S, Maiorana A, Geremia C, Scirè G, Spadoni GL, Germani D (2003) Blood glucose concentrations are reduced in children born small for gestational age (SGA), and thyroid-stimulating hormone levels are increased in SGA with blunted postnatal catch-up growth. J Clin Endocrinol Metab 88:2699–2705

    Article  CAS  PubMed  Google Scholar 

  18. Ong KK, Loos RJ (2006) Rapid infancy weight gain and subsequent obesity: systematic reviews and hopeful suggestions. Acta Paediatr 95:904–908

    Article  PubMed  Google Scholar 

  19. Wit JM, Finken MJ, Rijken M, de Zegher F (2006) Preterm growth restraint: a paradigm that unifies intrauterine growth retardation and preterm extrauterine growth retardation and has implications for the small-for-gestational-age indication in growth hormone therapy. Pediatrics 117:e793–e795

    Article  CAS  PubMed  Google Scholar 

  20. Saenger P, Czernichow P, Hughes I, Reiter EO (2007) Small for gestational age: short stature and beyond. Endocr Rev 28:219–251

    Article  CAS  PubMed  Google Scholar 

  21. Völkl TM, Haas B, Beier C, Simm D, Dörr HG (2006) Catch-down growth during infancy of children born small (SGA) or appropriate (AGA) for gestational age with short-statured parents. J Pediatr 148:747–752

    Article  PubMed  Google Scholar 

  22. Hay WW Jr, Lucas A, Heird WC, Ziegler E, Levin E, Grave GD, Catz CS, Yaffe SJ (1999) Workshop summary: nutrition of the extremely low birth weight infant. Pediatrics 104:1360–1368

    Article  PubMed  Google Scholar 

  23. Lapillonne A, Braillon P, Claris O, Chatelain PG, Delmas PD, Salle BL (1997) Body composition in appropriate and in small for gestational age infants. Acta Paediatr 86:196–200

    Article  CAS  PubMed  Google Scholar 

  24. Ounsted MK, Moar VA, Scott A (1984) Children of deviant birthweight at the age of seven years: health, handicap, size and developmental status. Early Hum Dev 9:323–340

    Article  CAS  PubMed  Google Scholar 

  25. Binkin NJ, Yip R, Fleshood L, Trowbridge FL (1988) Birth weight and childhood growth. Pediatrics 82:828–834

    CAS  PubMed  Google Scholar 

  26. Monteiro PO, Victora CG (2005) Rapid growth in infancy and childhood and obesity in later life—a systematic review. Obes Rev 6:143–154

    Article  CAS  PubMed  Google Scholar 

  27. Hediger ML, Overpeck MD, Kuczmarski RJ, McGlynn A, Maurer KR, Davis WW (1998) Muscularity and fatness of infants and young children born small- or large-for-gestational-age. Pediatrics 102:E60

    Article  CAS  PubMed  Google Scholar 

  28. De Groot L, de Groot CJ, Hopkins B (1997) An instrument to measure independent walking: are there differences between preterm and fullterm infants? J Child Neurol 12:37–41

    Article  PubMed  Google Scholar 

  29. Labarta JI, Ruiz JA, Molina I, De Arriba A, Mayayo E, Ferrádez-Longás A (2009) Growth and growth hormone treatment in short stature children born small for gestational age. Pediatr Endocrinol Rev 6:350–357

    PubMed  Google Scholar 

  30. Barker M, Robinson S, Osmond C, Barker DJ (1997) Birth weight and body fat distribution in adolescent girls. Arch Dis Child 77:381–383

    Article  CAS  PubMed  Google Scholar 

  31. Gale CR, Martyn CN, Kellingray S, Eastell R, Cooper C (2001) Intrauterine programming of adult body composition. J Clin Endocrinol Metab 86:267–272

    Article  CAS  PubMed  Google Scholar 

  32. Crescenzo R, Samec S, Antic V, Rohner-Jeanrenaud F, Seydoux J, Montani JP, Dulloo AG (2003) A role for suppressed thermogenesis favoring catch-up fat in the pathophysiology of catch-up growth. Diabetes 52:1090–1097

    Article  CAS  PubMed  Google Scholar 

  33. Cettour-Rose P, Samec S, Russell AP, Summermatter S, Mainieri D, Carrillo-Theander C, Montani JP, Seydoux J, Rohner-Jeanrenaud F, Dulloo AG (2005) Redistribution of glucose from skeletal muscle to adipose tissue during catch-up fat: a link between catch-up growth and later metabolic syndrome. Diabetes 54:751–756

    Article  CAS  PubMed  Google Scholar 

  34. Cooke RJ, Rawlings DJ, McCormick K, Griffin IJ, Faulkner K, Wells JC, Smith JS, Robinson SJ (1999) Body composition of preterm infants during infancy. Arch Dis Child Fetal Neonatal Ed 80:F188–F191

    Article  CAS  PubMed  Google Scholar 

  35. Ong KK (2006) Size at birth, postnatal growth and risk of obesity. Horm Res 65:65–69

    Article  CAS  PubMed  Google Scholar 

  36. Rodríguez-Soriano J, Aguirre M, Oliveros R, Vallo A (2005) Long-term renal follow-up of extremely low birth weight infants. Pediatr Nephrol 20:579–584

    Article  PubMed  Google Scholar 

  37. Tulassay T, Vásárhelyi B (2002) Birth weight and renal function. Curr Opin Nephrol Hypertens 11:347–352

    Article  PubMed  Google Scholar 

  38. Luyckx VA, Brenner BM (2005) Low birth weight, nephron number, and kidney disease. Kidney Int 97:S68–S77

    Article  Google Scholar 

  39. Sas T, de Waal W, Mulder P, Houdijk M, Jansen M, Reeser M, Hokken-Koelega A (1999) Growth hormone treatment in children with short stature born small for gestational age: 5-year results of a randomised, double-blind, dose-response trial. J Clin Endocrinol Metab 84:3064–3070

    Article  CAS  PubMed  Google Scholar 

  40. De Zegher F, Albertsson-Wikland K, Wollmann HA, Chatelain P, Chaussain JL, Löfström A, Johnsson B, Rosenfeld RG (2000) 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 85:2816–2821

    Article  PubMed  Google Scholar 

  41. Van Pareren Y, Mulder P, Houdijk M, Cansen M, Reeser M, Hokken-Koelega A (2003) Adult height after long-term, continuous growth hormone (GH) treatment in short children born small for gestational age: results of a randomised, double-blind, dose-response GH trial. J Clin Endocrinol Metab 88:3583–3590

    Google Scholar 

  42. De Zegher F, Hokken-Koelega A (2005) Growth hormone therapy for children born small for gestational age: height gain is less dose dependent over the long term than over the short term. Pediatrics 115:458–462

    Article  Google Scholar 

  43. Phillip M, Lebenthal Y, Lebl J, Zuckerman-Levin N, Korpal-Szczyrska M, Marques JS, Steensberg A, Jons K, Kappelgaard AM, Ibáñez L, European Norditropin SGA Study Group (2009) European multicentre study in children born small for gestational age with persistent short stature: comparison of continuous and discontinuous growth hormone treatment regimens. Horm Res 71:52–59

    Article  CAS  PubMed  Google Scholar 

  44. Argente J, Gracia R, Ibáñez L, Oliver A, Borrajo E, Vela A, López-Siguero JP, Moreno ML, Rodríguez-Hierro F (2007) Improvement in growth after two years of growth hormone therapy in very young children born small for gestational age and without spontaneous catch-up growth: results of a multicenter, controlled, randomized, open clinical trial. J Clin Endocrinol Metab 92:3095–3101

    Article  CAS  PubMed  Google Scholar 

  45. Dahlgren J, Wikland KA, Swedish Study Group for Growth Hormone Treatment (2005) Final height in short children born small for gestational age treated with growth hormone. Pediatr Res 57:216–222

    Article  CAS  PubMed  Google Scholar 

  46. Ester WA, van Meurs JB, Arends NJ, Uitterlinden AG, de Ridder MA, Hokken-Koelega AC (2009) Birth size, postnatal growth and growth during growth hormone treatment in small-for-gestational-age children: associations with IGF1 gene polymorphisms and haplotypes? Horm Res 72:15–24

    Article  CAS  PubMed  Google Scholar 

  47. Van der Kaay DC, Hendriks AE, Ester WA, Leunissen RW, Willemsen RH, de Kort SW, Paquette JR, Hokken-Koelega AC, Deal CL (2009) Genetic and epigenetic variability in the gene for IGFBP-3 (IGFBP3): correlation with serum IGFBP-3 levels and growth in short children born small for gestational age. Growth Horm IGF Res 19:198–205

    Article  PubMed  Google Scholar 

  48. Wingen AM, Fabian-Bach C, Schaefer F, Mehls O (1997) Randomised multicentre study of a low-protein diet on the progression of chronic renal failure in children. European Study Group of Nutritional Treatment of Chronic Renal Failure in Childhood. Lancet 349:1117–1123

    Article  CAS  PubMed  Google Scholar 

  49. ESCAPE Trial Group, Wühl E, Trivelli A, Picca S, Litwin M, Peco-Antic A, Zurowska A, Testa S, Jankauskiene A, Emre S, Caldas-Afonso A, Anarat A, Niaudet P, Mir S, Bakkaloglu A, Enke B, Montini G, Wingen AM, Sallay P, Jeck N, Berg U, Caliskan S, Wygoda S, Hohbach-Hohenfellner K, Dusek J, Urasinski T, Arbeiter K, Neuhaus T, Gellermann J, Drozdz D, Fischbach M, Möller K, Wigger M, Peruzzi L, Mehls O, Schaefer F (2009) Strict blood-pressure control and progression of renal failure in children. N Engl J Med 361:1639–1650

    Article  PubMed  Google Scholar 

  50. Karlberg J, Schaefer F, Hennicke M, Wingen AM, Rigden S, Mehls O (1996) Early age-dependent growth impairment in chronic renal failure. European Study Group for Nutritional Treatment of Chronic Renal Failure in Childhood. Pediatr Nephrol 10:283–287

    CAS  PubMed  Google Scholar 

  51. Zivicnjak M, Alakan H, Ehrich JH, Niedenzu J, Querfeld U, Pavicic L, Franke D (2009) Intrauterine growth relates to the need of growth hormone therapy in children with chronic kidney disease (CKD). Pediatr Nephrol 24:899, (abstract)

    Google Scholar 

  52. Franke DU, Völker S, Haase S, Ehrich JH, Querfeld U, Pavicic L, Zivicnjak M (2009) Intrauterine growth differs in children with congenital, hereditary and acquired chronic kidney disease. Pediatr Nephrol 24:899, (abstract)

    Article  Google Scholar 

  53. Weber S, Moriniere V, Knüppel T, Charbit M, Dusek J, Ghiggeri GM, Jankauskiené A, Mir S, Montini G, Peco-Antic A, Wühl E, Zurowska AM, Mehls O, Antignac C, Schaefer F, Salomon R (2006) Prevalence of mutations in renal developmental genes in children with renal hypodysplasia: results of the ESCAPE study. J Am Soc Nephrol 17:2864–2870

    Article  CAS  PubMed  Google Scholar 

  54. Weber S, Taylor JC, Winyard P, Baker KF, Sullivan-Brown J, Schild R, Knüppel T, Zurowska AM, Caldas-Alfonso A, Litwin M, Emre S, Ghiggeri GM, Bakkaloglu A, Mehls O, Antignac C, Network E, Schaefer F, Burdine RD (2008) SIX2 and BMP4 mutations associate with anomalous kidney development. J Am Soc Nephrol 19:891–903

    Article  CAS  PubMed  Google Scholar 

  55. Tabatabaeifar M, Schlingmann KP, Litwin M, Emre S, Bakkaloglu A, Mehls O, Antignac C, Schaefer F, Weber S, ESCAPE Trial Group (2009) Functional analysis of BMP4 mutations identified in pediatric CAKUT patients. Pediatr Nephrol 24:2361–2368

    Article  PubMed  Google Scholar 

  56. Woolf AS, Price KL, Scambler PJ, Winyard PJ (2004) Evolving concepts in human renal dysplasia. J Am Soc Nephrol 15:998–1007

    Article  PubMed  Google Scholar 

  57. Schaefer F, Seidel C, Binding A, Gasser T, Largo RH, Prader A, Schärer K (1990) Pubertal growth in chronic renal failure. Pediatr Res 28:5–10

    Article  CAS  PubMed  Google Scholar 

  58. Haffner D, Fischer DC (2009) Growth hormone treatment of infants with chronic kidney disease: requirement, efficacy, and safety. Pediatr Nephrol 24:1097–1100

    Article  PubMed  Google Scholar 

  59. Mencarelli F, Kiepe D, Leozappa G, Stringini G, Cappa M, Emma F (2009) Growth hormone treatment started in the first year of life in infants with chronic renal failure. Pediatr Nephrol 24:1039–1046

    Article  PubMed  Google Scholar 

  60. Franke D, Zivicnjak M, Ehrich JH (2009) Growth hormone treatment of renal growth failure during infancy and early childhood. Pediatr Nephrol 24:1093–1096

    Article  PubMed  Google Scholar 

  61. Haffner D, Wühl E, Schaefer F, Nissel R, Tönshoff B, Mehls O (1998) Factors predictive of the short- and long-term efficacy of growth hormone treatment in prepubertal children with chronic renal failure. The German Study Group for Growth Hormone Treatment in Chronic Renal Failure. J Am Soc Nephrol 9:1899–1907

    CAS  PubMed  Google Scholar 

  62. Haffner D, Schaefer F, Nissel R, Wühl E, Tönshoff B, Mehls O (2000) Effect of growth hormone treatment on the adult height of children with chronic renal failure. German Study Group for Growth Hormone Treatment in Chronic Renal Failure. N Engl J Med 343:923–930

    Article  CAS  PubMed  Google Scholar 

  63. Mehls O, Lindberg A, Bettendorf M, Doerr HG, Hauffa BP, Kaspers S, Rohrer T, Stahnke N, Ranke MB, German KIGS Board (2009) Is the response to growth hormone in short children born small for gestational age dependent on genetic or maternal factors? Horm Res 72:106–113

    Article  CAS  PubMed  Google Scholar 

  64. Ester W, Bannink E, van Dijk M, Willemsen R, van der Kaay D, de Ridder M, Hokken-Koelega A (2008) Subclassification of small for gestational age children with persistent short stature: growth patterns and response to GH treatment. Horm Res 69:89–98

    Article  CAS  PubMed  Google Scholar 

  65. De Kort SW, Willemsen RH, van der Kaay DC, Duivenvoorden HJ, Hokken-Koelega AC (2009) Does preterm birth influence the response to growth hormone treatment in short, small for gestational age children? Clin Endocrinol (Oxf) 70:582–587

    Article  Google Scholar 

  66. Mehls O, Lindberg A, Nissel R, Haffner D, Hokken-Koelega A, Ranke MB (2009) Predicting the response to growth hormone treatment in short children with chronic kidney disease. J Clin Endocrinol Metab. doi:10.1210/jc.2009-1114

    PubMed  Google Scholar 

  67. Litwin M, Wühl E, Jourdan C, Niemirska A, Schenk JP, Jobs K, Grenda R, Wawer ZT, Rajszys P, Mehls O, Schaefer F (2008) Evolution of large-vessel arteriopathy in paediatric patients with chronic kidney disease. Nephrol Dial Transplant 23:2552–2557

    Article  PubMed  Google Scholar 

  68. Matteucci MC, Wühl E, Picca S, Mastrostefano A, Rinelli G, Romano C, Rizzoni G, Mehls O, de Simone G, Schaefer F, ESCAPE Trial Group (2006) Left ventricular geometry in children with mild to moderate chronic renal insufficiency. J Am Soc Nephrol 17:218–226

    Article  PubMed  Google Scholar 

  69. Chinali M, de Simone G, Matteucci MC, Picca S, Mastrostefano A, Anarat A, Caliskan S, Jeck N, Neuhaus TJ, Peco-Antic A, Peruzzi L, Testa S, Mehls O, Wühl E, Schaefer F, ESCAPE Trial Group (2007) Reduced systolic myocardial function in children with chronic renal insufficiency. J Am Soc Nephrol 18:593–598

    Article  PubMed  Google Scholar 

  70. Wühl E, Mehls O, Schaefer F, ESCAPE Trial Group (2004) Antihypertensive and antiproteinuric efficacy of ramipril in children with chronic renal failure. Kidney Int 66:768–776

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Endocrinology, Hospital Infantil Universitario Nino Jesús, Madrid, Spain

    Jesús Argente & Vicente Barrios

  2. Department of Pediatrics, Universidad Autónoma de Madrid, Madrid, Spain

    Jesús Argente & Vicente Barrios

  3. CIBER Fisiopatología de la Obesidad y Nutrición, Instituto Carlos III, Madrid, Spain

    Jesús Argente & Vicente Barrios

  4. Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, Heidelberg, Germany

    Otto Mehls

  5. Department of Pediatrics, Hospital Infantil Universitario Niño Jesús, Avda. Menéndez Pelayo, 65, 28009, Madrid, Spain

    Jesús Argente

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Correspondence to Jesús Argente.

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Argente, J., Mehls, O. & Barrios, V. Growth and body composition in very young SGA children. Pediatr Nephrol 25, 679–685 (2010). https://doi.org/10.1007/s00467-009-1432-2

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