Subclassification of small for gestational age children with persistent short stature: growth patterns and response to GH treatment.
OBJECTIVE
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(L), SGA(L+W) and SGA(L+W+HC), according to birth length (L), weight (W) and head circumference (HC) < or =-2.00 standard deviation score (SDS).


RESULTS
SGA(L+W+HC) children were born after the shortest gestational age and more often by caesarean section than SGA(L) children (36.3 vs. 38.1 weeks, 68.4 vs. 24.4%). SGA(L+W) children had an intermediate pattern and experienced most gestational hypertension (p = 0.01). At birth, SGA(L+W+HC) children were shorter than SGA(L) or SGA(L+W) (-4.12 vs. -2.67 and -3.72 SDS, p < or = 0.001). During the first 3 years of life, SGA(L+W+HC) children exhibited an increased growth in height (0.98 SDS) and HC (1.28 SDS) than SGA(L) (height, -0.06 SDS; HC, -0.30 SDS) and SGA(L+W) (height, 0.62 SDS; HC, -0.31 SDS). However, HC SDS remained smaller for SGA(L+W+HC) than the other groups at age 3. The groups did not differ in growth response during GH treatment. SGA(L) children tended to have shorter parents and target height than SGA(L+W+HC) 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.
Ester
Wietske
W
Department of Pediatrics, Division of Endocrinology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands. w.ester@erasmusmc.nl
Bannink
Ellen
E
van Dijk
Marije
M
Willemsen
Ruben
R
van der Kaay
Danielle
D
de Ridder
Maria
M
Hokken-Koelega
Anita
A
D001724:Birth Weight; D001827:Body Height / Q000187:drug effects; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D006130:Growth Disorders / Q000145:classification* / Q000188:drug therapy* / Q000209:etiology; D013006:Growth Hormone / Q000627:therapeutic use*; D020249:Hormone Replacement Therapy; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age / Q000254:growth & development*; D010290:Parents
D013006:Growth Hormone