Symmetrical and asymmetrical growth restriction in preterm-born children.
OBJECTIVE
To determine how symmetric (proportionate; SGR) and asymmetric (disproportionate; AGR) growth restriction influence growth and development in preterms from birth to 4 years.


METHODS
This community-based cohort study of 810 children comprised 86 SGR, 61 AGR, and 663 non-growth restricted (NGR) preterms, born in 2002 and 2003. Symmetrical growth restriction was defined as a birth weight below the 16th percentile (-1 SD) compared with full-terms and a head circumference (HC) z score not exceeding the infant's birth weight z score by >1 SD. Asymmetric growth restriction was defined as a HC z score exceeding that for by >1 SD as a proxy of brain sparing. Developmental delay was assessed by the Ages and Stages Questionnaire at 4 years.


RESULTS
Longitudinal gains in weight and height were similar for SGR and AGR children and less compared with NGR children. At age 4, z scores for weight were -1.1 for SGR and -0.7 for AGR children vs -0.3 for NGR children. z scores for height were -0.8 and -0.5 vs. -0.2. HC gain were 2 cm more in SGR, but at 1 year, they were -0.2 vs. 0.2 (AGR) and 0.1 (NGR). Developmental delay increased with odds ratios of 2.5 (95% confidence interval 1.1-6.0) for SGR and 2.1 (95% confidence interval 0.7-5.9) for AGR.


CONCLUSIONS
Weight and height gains were similar for AGR and SGR children but poorer compared with NGR children. SGR children caught up on HC. Developmental delay was more likely in growth-restricted preterms independent of HC at birth.
Departments of Pediatrics, Division of Neonatology, and.
Inger
I
Bocca-Tjeertes
Arend
A
Bos
Jorien
J
Kerstjens
Andrea
A
de Winter
Sijmen
S
Reijneveld
D001827:Body Height / Q000502:physiology*; D001835:Body Weight / Q000502:physiology*; D002675:Child, Preschool; D015331:Cohort Studies; D002658:Developmental Disabilities / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D005260:Female; D006130:Growth Disorders / Q000175:diagnosis* / Q000453:epidemiology* / Q000503:physiopathology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature / Q000254:growth & development; D008137:Longitudinal Studies; D008297:Male; D047928:Premature Birth / Q000175:diagnosis* / Q000453:epidemiology* / Q000503:physiopathology; D012189:Retrospective Studies
appropriate for gestational age; asymmetric; development; fetal growth; growth; growth restriction; preterm; small for gestational age; symmetric