[Retardation of intrauterine growth. Prognosis and therapeutic perspectives]

Intra-uterine growth retardation (IUGR) comprises a heterogeneous population of infants due to the variety of causes and degrees of severity. Among the risk factors, smoking, maternal weight gain, age and disease state as well as socioeconomical, nutritional and environmental factors would be susceptible to preventive measures while others such as ethnic origin, parity and genetic potential lie beyond the scope of medical management. Still other factors remain unknown since as many as 30% of the small-for-gestational age births are labelled idiopathic. Factors predicting post-natal growth rate and catch-up growth are poorly understood. Prematurity and very low birthweight are risk factors leading to delayed growth. Maternal alcoholism may be responsible for neurosensorial handicaps and certain authors suggest this population is more susceptible to delayed growth. Inversely, the severity of hormone disorders at birth and sex apparently have no predictive value. Preliminary studies report the effects of growth hormone therapy in children with short stature secondary to intra-uterine growth retardation and indicate significant results in these patients with a normal secretion of endogenous growth hormone. At 1.2-1.4 IU/kg/week of hGH (3 times the dose given in cases of GH insufficiency) height increases by one standard deviation during the first two years of treatment without excessive bone maturation. The exact dose required and the optimal age for initiating treatment as well as long-term effects remain to be ascertained.