First two years' response to growth hormone treatment in very young preterm small for gestational age children.

BACKGROUND: Growth hormone (GH) is a therapeutic option for small for gestational age (SGA) children without spontaneous catch-up. There are few reports on preterm SGA children. Prematurity is an additional risk factor for adult short stature. AIM: To describe GH efficacy in preterm SGA patients. METHODS: Twenty-five preterm SGA patients, 2-4 years old, treated with GH 0.066 mg/kg/day, were compared with 14 age-matched preterm SGA historical controls. Height, weight, IGF-I, IGFBP-3, fasting glucose and insulin were measured every 6 months. RESULTS: At start of GH treatment, mean height and weight were -2.4 and -2.4 SDS, respectively. There was a significant increment in height SDS of 1.3 and 2.1 during the 1st and the 2nd year of GH therapy, respectively. There was no significant difference between the progression of chronological and bone ages. A significant increase in IGF-I, IGFBP-3 and molar ratio was observed during GH therapy. There was no difference in glucose, insulin or HOMA-IR index. CONCLUSION: We showed for the first time that the height increment of preterm SGA with GH treatment is similar to that described in other studies with term SGA patients. Therefore, short-term GH treatment in a subset of preterm SGA patients between 2-4 years of age was able to promote adequate growth recovery with no excessive bone age acceleration or adverse effects on carbohydrate metabolism.

Fatores maternos e fetais associados ao nascimento de prematuros com 1.000 gramas ou menos. / Maternal and fetal factores associated with the birth of premature of 1,000g or less

O perfil das gestantes de baixo nivel socio-economico em nossa pesquisa, que deram a luz prematuros com 1.000 g ou menos, tem as seguintes caracteristicas: - nao eram primigestas; - tinham idade media de 26,6 anos; - nao fizeram seguimento pre-natal; - apresentaram alguma complicacao gestacional.Nao foi verificada nenhuma influencia da cor, estado civil e ocorrencia de abortos anteriores. O parto foi normal em 83,82% dos casos e a apresentacao cefalica em 77,94% das vezes. O bebe nasceu gravemente deprimido em 67,69% dos casos e com idade gestacional entre 22 e 30 semanas em 58,82% das vezes, sendo que 50,9% foram adequados para a idade gestacional e os demais; pequenos para a idade gestacional.As mortes neonatais ocorreram em 75% dos casos ate o 10o. dia de vida. Nos achados de necropsia predominaram: imaturidade cerebral e renal, atelectasia pulmonar congestao visceral generalizada e as sufusoes hemorragicas multiplas. Houve baixas-incidencias de persistencia do canal arterial e de membrana hialina