The Optimal Postnatal Growth Trajectory for Term Small for Gestational Age Babies: A Prospective Cohort Study - 25/10/14

Doi : 10.1016/j.jpeds.2014.09.025

Xiaoping Lei, MD ^1,^2,^{^{∗
Contributed equally.}}, Yan Chen, MD ^1,^{^{∗
Contributed equally.}}, Jiangfeng Ye, MD, PhD ¹, Fengxiu Ouyang, MD, PhD ¹, Fan Jiang, MD, PhD ³, Jun Zhang, PhD, MD ^1,^4,^⁎
¹ MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
² Department of Neonatology, Affiliated Hospital of Luzhou Medical College, Luzhou, Sichuan, China
³ Department of Child Development and Behavior, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
⁴ Shanghai Jiao Tong University School of Public Health, Shanghai, China

^∗Reprint requests: Jun Zhang, MD, PhD, MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, 1665 Kong Jiang Rd, Shanghai 200092, China.

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Saturday 25 October 2014

Abstract

Objectives

To identify an optimal growth trajectory for term small for gestational age (SGA) babies from birth to 7-years-old.

Study design

Data were from the Collaborative Perinatal Project, a US multicenter prospective cohort study from 1959-1976. Five weight growth trajectories of the 1957 term SGA babies were grouped by a latent class model. We selected the optimal growth pattern based on the lowest overall risks of childhood diseases.

Results

Compared with appropriate for gestational age children, SGA babies with no catch-up growth (439, 22.4%) had higher risks of infection in infancy (aOR 1.2, 95% CI 1.0-1.6), growth restriction (11.2, 8.6-14.6), and low IQ (2.1, 1.7-2.8) at age 7 years. Those with excessive catch-up growth (176, 8.9%) had higher risks of overweight/obesity (7.5, 5.4-10.5) and elevated blood pressure (1.7, 1.1-2.4) at age 7 years. Babies with slow catch-up growth (328, 16.8%) or regression after 4 months (285, 14.6%) were associated with higher risks of low IQ (1.6, 1.2-2.1) and growth restriction (2.2, 1.5-3.2), respectively. Only babies with appropriate catch-up growth (729, 37.3%) did not have increased risk of adverse outcomes. Further, we also tested linear growth trajectories with similar findings.

Conclusions

The optimal growth trajectory for term SGA infants may be fast catch-up growth to about the 30th percentile in the first several months, with modest catch-up growth thereafter, to be around the 50th percentile by 7-years-old.

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Keyword : AGA, CDC, CPP, LMP, SGA