Harding J E, McCowan L M E
Departments of Paediatrics and Obstetrics, Faculty of Medicine and Health Science, University of Auckland, Private Bag 92019, Auckland, New Zealand.
Early Hum Dev. 2003 Oct;74(1):13-26. doi: 10.1016/s0378-3782(03)00080-x.
To determine factors before or at birth that are predictive of growth patterns to 18 months in children born small for gestational age (SGA).
Prospective cohort study of 186 SGA babies. Catch-up growth patterns were defined as early (>10th centile at 6 and 18 months), late (<10th centile at 6 months but >10th centile at 18 months), transient (>10th centile at 6 months but <10th centile at 18 months) or none (<10th centile at 6 and 18 months).
Most children (75%) showed catch-up growth by 6 months. Of antenatal variables studied, only early gestation at diagnosis of SGA predicted late or failed catch-up. Late or failed catch-up was also associated with short gestation, small absolute and relative size at birth, increased placental weight/birthweight ratio (Pl/BW) and prolonged neonatal hospital stay. On logistic regression, both late and failed catch-up were associated with short birth length. Late catch-up growth was also associated with prolonged hospital stay and male sex. Failed catch-up was associated with increased Pl/BW. No antenatal or perinatal variables distinguished early from transient catch-up groups.
SGA babies with late onset and less severe growth restriction have a good chance of catch-up growth by 6 months of age. Catch-up growth is likely to be delayed in SGA babies who are short at birth, are boys, and have prolonged hospital stays. However, poor growth over the first 6 months does not predict later growth patterns. Failure of catch-up growth in babies with increased Pl/BW may reflect an intrinsic growth defect. Transient catch-up growth may reflect environmental factors operating after birth.
确定小于胎龄儿（SGA）出生前或出生时可预测其18个月生长模式的因素。
对186名SGA婴儿进行前瞻性队列研究。追赶生长模式分为早期（6个月和18个月时均>第10百分位数）、晚期（6个月时<第10百分位数但18个月时>第10百分位数）、短暂性（6个月时>第10百分位数但18个月时<第10百分位数）或无追赶生长（6个月和18个月时均<第10百分位数）。
大多数儿童（75%）在6个月时出现追赶生长。在所研究的产前变量中，仅SGA诊断时的孕周早可预测晚期或追赶生长失败。晚期或追赶生长失败还与孕周短、出生时绝对和相对体型小、胎盘重量/出生体重比（Pl/BW）增加以及新生儿住院时间延长有关。经逻辑回归分析，晚期和追赶生长失败均与出生身长较短有关。晚期追赶生长还与住院时间延长和男性性别有关。追赶生长失败与Pl/BW增加有关。没有产前或围产期变量能区分早期和短暂性追赶生长组。
起病较晚且生长受限程度较轻的SGA婴儿在6个月龄时有较好的追赶生长机会。出生时身材矮小、为男孩且住院时间延长的SGA婴儿追赶生长可能会延迟。然而，前6个月生长不良并不能预测后期生长模式。Pl/BW增加的婴儿追赶生长失败可能反映了内在生长缺陷。短暂性追赶生长可能反映了出生后起作用的环境因素。
