Growth During the First Two Years Predicts Pre-School Height in Children Born With Very Low Birth Weight (VLBW): Results of a Study of 1,320 Children in Germany

Abstract

Children born with very low birth weight (VLBW) are at risk of impaired growth. We aimed to study VLBW survivors (90.8%) born in 1998/1999 in the state of Baden-Württemberg (n ϭ 2103) for whom growth data were available up to age six. Classification as appropriate for gestational age (AGA) or small for gestational age (SGA) depended on size at birth. Models to predict height SDS at 5 y were developed using data for 1 yr (Model 1) and 2 yrs (Model 2). The data of 1320 (63%) children were available: SGA: n ϭ 730, AGA: n ϭ 590. At 6 yrs, 8.3% AGA and 13.4% SGA children were short (ϽϪ2.0 SDS). The following factors explained Ht SDS at 5 (and 6) yrs (order of importance): (a) Model 1 (n ϭ 1033; R 2 ϭ 0. A lthough the frequency of premature births has risen during the last decades, the number of surviving babies has risen due to improved perinatal care. This holds particularly true for children with very low birth weight (VLBW; BW Ͻ 1500 g), as their survival rate has reached about 90% (1). Several reports have shown more frequent impairments in growth development in this group in comparison to other prematurely born children with higher birth weights (2-9). After Barker and colleagues established that low birth weight was a major determinant of mortality and morbidity in adult life (10), overwhelming evidence became available from epidemiologic studies which show that impaired birth weight is associated with a higher prevalence of the metabolic syndrome. It has therefore been hypothesized that an impairment in prenatal growth influences the long-term "metabolic programme" of an individual. Several authors have reported that children born small for gestational age (SGA) showed impaired growth in contrast to children whose birth length was appropriate for gestational age (AGA). However the main group studied in these reports involved either children with birth weights higher than 1500 g (11-14) or VLBW children born earlier than 1990 (3,5,6,15,16). Our study of VLBW children was aimed at investigating growth development from birth until early school age and at identifying the factors to predict their height development during childhood. The two birth cohorts we studied derived from the state birth register in Baden-Württemberg in Germany for the years 1998 and 1999, respectively. METHODS Population.The state of Baden-Wuerttemberg represents about 10% of Germany's geographical area and approximately 13% of its population. According to the state birth register, there were 108,000 births in 1998 and 111,000 in 1999 (17). Of these, 2316 VLBW babies were born and 2103 (90.8%) of them survived (1). There are 30 neonatal intensive care units (NICU) in Baden-Wuerttemberg, including four university hospitals; and all excepting two small units participated in our study (see Acknowledgements).Data collection. In 2004, birth and follow-up data were available for 2040 (97%) surviving children born VLBW. Parents were sent a questionnaire and a description of the study by post. 1322 (62.9%) families returned the questionnai...

Patterns of Growth after Kidney Transplantation among Children with ESRD

“…Whether a more vigorous treatment will translate into better growth outcome in KTx patients needs to be proven in future trials. Intrauterine growth restriction and parental height are significant predictors of total body height in the general population and in children with CKD (27)(28)(29)(30)(31). Malnutrition is an important factor contributing to growth failure in children with CKD, especially during young age.…”

Growth of Preterm Born Children

“…Similar to term infants born SGA, most preterm born infants (approximately 80%) show catch-up growth in weight, length and head circumference after initial postnatal growth failure [60,61,62,63], generally starting early in the first months of life and often achieved within the first 2 years of life [60,61,62, 64, 65]. However, late catch-up growth of preterm subjects has been described throughout childhood [62, 63] and even in adolescence [66,67,68]. …”

“…In preterm infants early growth and genetic potential as reflected by parental height seem important for catch-up growth in height as well, though this effect might be different for different durations of gestation [62, 63, 67, 78, 79]. Examples of specific genetic polymorphisms that have both been related to increased postnatal catch-up growth in preterm infants are the d3-isoform polymorphism of the growth hormone receptor gene [80], and the R23K polymorphism in the glucocorticoid receptor gene [81].…”

“…The following factors explained height SDS at 5 years: height SDS at 1 year, mid-parental height SDS, 1st year weight SDS, and birth weight SDS [62]. We have shown that infants born very preterm who reach the normal range for length (>–2 SDS) at 3 months post-term display a virtually normal growth pattern in childhood, adolescence and adulthood, but infants who do not catch up (labelled pre-term growth restraint, PGR) show a similar growth pattern as term born SGA babies.…”

“…Most studies have shown that postnatal corticosteroid treatment has a negative effect on postnatal catch-up [64, 82, 83], but others did not find such effect [61,84,85,86]. Other factors that have been negatively related to later (catch-up) growth in preterm infants include male gender [3], medical complications [87] and being born SGA [60,61,62,63, 88]. …”