Growth Hormone Treatment of the Short Child Born Small for Gestational Age
Intrauterine growth retardation (IUGR) is a pathologic condition where fetal growth is restrained by either extrinsic (maternal) factors or a disorder intrinsic to the fetus itself. This is a significant problem because of the morbidity that accompanies I
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Growth Hormone Treatment of the Short Child Born Small for Gestational Age Steven D. Chernausek
Abstract
Intrauterine growth retardation (IUGR) is a pathologic condition where fetal growth is restrained by either extrinsic (maternal) factors or a disorder intrinsic to the fetus itself. This is a significant problem because of the morbidity that accompanies IUGR. The effect of IUGR on subsequent growth and its amelioration by growth hormone (GH) is the focus of this chapter. Keywords
Growth hormone • Small for gestational age • Intrauterine growth restriction • Insulin-like growth factor I • Short stature • Growth
Introduction Intrauterine growth retardation (IUGR) is a pathologic condition where fetal growth is restrained by either extrinsic (maternal) factors or a disorder intrinsic to the fetus itself. Each year, nearly 14 million infants are born following IUGR worldwide [1]; rates are especially high in developing countries because of poor nutrition and limited prenatal care. This is a significant
S.D. Chernausk, M.D. (*) Department of Pediatrics, Pediatric Endocrinology, University of Oklahoma Health Sciences Center, 1200 Children’s Way, Suite 4500, Oklahoma City, OK 73104-4600, USA e-mail: [email protected]
problem because of the morbidity that accompanies IUGR. Complications in the immediate postpartum period include hypoglycemia, necrotizing enterocolitis, and persistence of the fetal circulation, to name a few [2]. Moreover, the first-year survival rate is substantially reduced in infants who have experienced IUGR [3]. There are long-term sequelae of IUGR as well. Affected children may have poor school performance and attenuated intellectual development [4]. There is evidence that intrauterine nutrient deprivation leads to obesity, insulin resistance, and hyperlipidemia later in life, an effect thought to be due to in utero “programming” of metabolic status [5]. Postnatal growth is also affected adversely. Somewhere between 10 and 40% of children who are born following IUGR remain growth-retarded in childhood [6, 7]. Many never reach normal adult size. The effect of IUGR on
S. Radovick and M.H. MacGillivray (eds.), Pediatric Endocrinology: A Practical Clinical Guide, Second Edition, Contemporary Endocrinology, DOI 10.1007/978-1-60761-395-4_5, © Springer Science+Business Media New York 2013
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subsequent growth and its amelioration by growth hormone (GH) is the focus of this chapter. The percentage of newborns said to have had IUGR depends on the definition applied, but generally is around 3% in the United States and 10% in developing countries. It is important to consider definitions used to define IUGR as they have some bearing on interpretation of published reports. IUGR (or intrauterine growth restriction) is a failure to grow at a normal rate in the in utero environment. Sequential measurements of fetal size in utero are usually not available, and therefore, IUGR is infrequently documented with precision and the phase of pregnancy during which the growth aberrat
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