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Assessment of short stature in very low birthweight children
L W Doyle1, G W Ford, B Abadilla
1Department of Obstetrics, Gynaecology, University of Melbourne, Parkville, Victoria, Australia.
Insights
Short very low birthweight (VLBW) children rarely have organic growth failure causes. Most short VLBW children do not qualify for growth hormone therapy, with few families pursuing full evaluation.
Area of Science:
- Pediatrics
- Endocrinology
- Growth and Development
Background:
- Short stature in children born with very low birthweight (VLBW) is a concern for parents and clinicians.
- Previous studies suggest potential for growth failure and eligibility for growth hormone therapy in some VLBW individuals.
Purpose of the Study:
- To investigate unsuspected organic causes of growth failure in short very low birthweight (VLBW) children.
- To assess the suitability of these children for synthetic growth hormone treatment.
Main Methods:
- Retrospective analysis of 195 very low birthweight (VLBW) children at or after 8 years of age.
- Height measurements, parental height assessment, and bone age determination were performed.
- Eligibility criteria for synthetic growth hormone therapy were evaluated.
Main Results:
- 19% of VLBW children were short (<10th percentile); only 40% of eligible families pursued full evaluation.
- No unsuspected organic causes for short stature were identified.
- Children's height was consistent with parental stature and bone age; only 3 children qualified for growth hormone therapy.
Conclusions:
- Short VLBW children are unlikely to have undiagnosed organic growth issues.
- A small proportion of short VLBW children meet criteria for synthetic growth hormone therapy.
- Family concern and pursuit of evaluation for short stature in VLBW children are limited.
Abstract:
The aims of this study of short very low birthweight (VLBW) children at or after 8 years of age were to determine: (i) if there were any unsuspected organic causes for their growth failure; and (ii) whether any children might be suitable for treatment with synthetic growth hormone. Thirty-seven of 195 (19%) VLBW children seen at 8 years had heights < 10th centile, and of these only 40% (10/25) of families offered an assessment were concerned enough to have the child fully evaluated. No child had an unsuspected organic cause of short stature. The children's parents were significantly shorter than expected for Caucasians (mean parental height s.d. score = -1.06 (s.d. 0.72), t = -5.9, P < 0.001). On average, the bone age of the short children was delayed by 14.9 months (s.d. 18.8 months) compared with chronological age (t = -3.4, P < 0.01). When compared with their parents, the children's mean height s.d. score for their bone age was not significantly different (mean height s.d. score for bone age = -0.83 (s.d. 1.3), t = 0.6, NS). Only three children qualified for treatment with synthetic growth hormone; all three had been small for gestational age at birth and had birthweights < 1000 g. In conclusion, in short VLBW children, only a minority of families and children are likely to be concerned enough about short stature to be fully assessed; an unsuspected organic cause for growth failure is unlikely, and only a few will qualify for synthetic growth hormone therapy.