Symmetrical and Asymmetrical Growth Restriction in Preterm-Born Children

Abstract

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.

Growth Asymmetry, Head Circumference, and Neurodevelopmental Outcomes in Infants with Single Ventricles

“…6, 31–33 Such complexity makes it difficult to define clinical growth objectives and suggests that forcing somatic growth with caloric supplementation is an oversimplified approach. Weight gain without a proportional increase in length may be detrimental.…”

Neurodevelopmental outcomes in postnatal growth-restricted preterm infants with postnatal head-sparing

“…A recent study of outcomes in preterm infants growth-restricted at birth used z-scores to define restricted growth and classify infants as either symmetric or asymmetric, but did so with measurements obtained at a single time point (birth). 8 Using a single measurement, such as z-score at birth or at discharge, prevents the ability to draw conclusions about the pattern of in-hospital growth. In addition, doing so would lead to exclusion and inclusion bias, whereby some infants with poor growth would be excluded (HC remains greater than a specified z-score or percentile) and others with ‘normal’ postnatal growth might be included (HC remains less than specified z-score or percentile).…”

“…Small for gestational age neonates born term and preterm with relative head sparing have neurodevelopmental outcomes that are significantly better than those babies whose head circumference percentiles are the same or lower than their birthweight percentiles. 8, 9, 10 The objective of this study was to compare neurodevelopmental outcomes in postnatal growth-restricted extremely preterm infants with and without PHS.…”

Somatic growth from birth to 6 months in low birth weight, in Bukavu, South Kivu, Democratic Republic of the Congo

“…Bocca-Tjeertes et al, in a study examining how symmetric growth restriction and asymmetric growth restriction influence growth and development in preterms from birth to 4 years, reported that up to age 4 years, symmetric growth restriction and asymmetric growth restriction preterm-born children failed to catch up on weight and height sufficiently, and that these preterm children could not keep up with the growth velocity of their non-growth restriction counter-parts. But, on the other hand, the HC growth of symmetric growth restriction exceeded that of asymmetric growth restriction and non-growth restriction, but still remained lower at age 1 year [58].…”