Head Circumference and Body Proportions Before and During Growth Hormone Treatment in Short Children Who Were Born Small for Gestational Age

Abstract

Objective. Although short children who were born small for gestational age (SGA) seem to have normal body proportions, objective data both before and during growth hormone (GH) treatment are very limited. Therefore, we investigated in a large group of short children who were born SGA the effects of GH treatment versus no treatment on head circumference (HC) and body proportions. Furthermore, we studied differences in linear growth and HC between SGA children who were born with a low birth length and birth weight (SGAL+W) and SGA children who were born with a low birth length only (SGAL). Methods. An open-labeled, GH-controlled, multicenter study was conducted for 3 years. Non–GH-deficient short SGA children (n = 87), with a mean age (standard deviation) of 5.9 (1.5) years, were randomized to either a GH group (n = 61), receiving GH in a dose of 33 μg/kg/day, or an untreated control group (n = 26). Height; weight; HC; sitting height; armspan; and hand, tibial, and foot size were measured and expressed as standard deviation score (SDS) adjusting for gender and age. Results. At baseline, all anthropometric measurements, except HC SDS, were significantly lower compared with −2 SDS. During GH treatment, all anthropometric measurements normalized in accordance to the normalization of height SDS. At the start of the study, mean HC SDS was significantly lower in SGAL+W children compared with SGAL children. It is interesting that most (14 of 16) children with an HC SDS less than −2.00 had been born SGAL+W. During GH treatment, the 3-year increase in height, HC, and other anthropometric measurements was comparable between SGAL+W and SGAL children. In both SGAL+W and SGAL control subjects, no changes in SDSs of height, HC, and other anthropometric measurements were found during the 3-year follow-up period. Conclusions. Untreated short SGA children have normal body proportions with the exception of HC, which is relatively large in many of these children. SGAL+W children still had a smaller HC at the age of 5.9 years compared with SGAL children. Three years of GH treatment induced a proportionate growth resulting in a normalization of height and other anthropometric measurements, including HC, in contrast to untreated SGA control subjects.