Preterm infants and use of GH in children who evolve with short stature
Posted October 2nd, 2020
Data from the Brazilian Ministry of Health show that, in Brazil, approximately 10% of infants are born preterm, i.e., before 37 weeks gestation. Advances in medicine and in hormone treatments have made it possible for most of them to develop and reach their genetic growth potential.
Studies reveal that growth hormone treatment in children born prematurely who remain with short stature is considered safe and effective. Good results were observed in studies assessing both growth during childhood and adolescence and adult height, but, before starting treatment, the reason for lack of catch-up growth should be identified.
Use of GH in children born small for gestational age
The study “Postnatal management of growth failure in children born small for gestational age,” J Pediatr, 2019, authored by the coordinator and researcher of INTC, Dr. Margaret Boguszewski, aimed to discuss the etiology and the consequences of size at birth. Moreover, the efficacy and safety of therapy with biosynthetic growth hormone in children born small for gestational age.
According to the article, GH therapy in children born small for gestational age who remain with short stature is considered safe and effective to improve overall status during childhood and adolescence and also in adult life. However, efforts should be made to identify the reason for lack of catch-up growth before starting treatment.
Dr. Boguszewski explains that some children born prematurely are also born small for gestational age. “The combination of the two situations increases the risk of remaining with short stature in the years following birth,” warns the researcher.
The survey also shows that hormone therapy may be indicated, preferably after 2 or 4 years of age, in children born small for gestational age who remain short, without catch-up growth. “The use of hormone aims to increase growth velocity and to reach a normal height during childhood and an adult height within target height,” explains the researcher.
She informs that response to treatment is variable, with better growth response during the pre-pubertal period.
Growth of preterm infants and intrauterine development
The doctoral thesis by Dr. Adriane Demartini, advised by Dr. Margaret Boguszewski and submitted to the Graduate Program in Child and Adolescence Health (Department of Health Sciences, Universidade Federal do Paraná), concluded that intrauterine growth and premature birth may bring consequences during the first years of life. Among these, the researcher highlights height growth impairment, early onset of puberty[U1] , and excess weight gain.
According to the study, preterm infants often present with serious postnatal growth failure, followed by catch-up growth after clinical stabilization. However, some of them did not present catch-up growth and may remain smaller than their term-born counterparts.
The survey also shows that some girls born prematurely may experience puberty a little earlier than usual, which is another factor that compromises adult height. Therefore, regular clinical follow-up is required during the entire growth and development stage.
The thesis was divided into two steps to describe growth and weight and height variations up to the seventh year of life among children born prematurely: one longitudinal retrospective assessment and another cohort assessment, in which children were recalled.
According to Dr. Boguszewski, approximately one third of preterm infants born with appropriate size for gestational age evolve with extrauterine growth retardation. There was an impairment in infants’ weight and/or height growth when they reached 40 weeks of postconceptional age.
From the study, the following conclusions were drawn:
- Most preterm infants show catch-up weight and height up to 2 years of postconceptional age;
- Gestational age below 32 weeks, short maternal height, being born small for gestational age, and extrauterine growth retardation were risk factors for short stature;
- Rapid weight gain in the first two years of life, BMI Z-score t 2 years of postconceptional age, and extrauterine growth retardation were risk factors for overweight/obesity;
- Exclusive breastfeeding in the first six months of life has an indirect protective role on overweight among school-age children.
[U1]AUTOR: por favor, confirme tradução.