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a Department of
Psychology, University of Hertfordshire, Hatfield, Hertfordshire, UK, b University of Munich Children's Hospital,
Munich, Germany
Correspondence to: Professor Wolke, Department of Psychology, Faculty of Health and Human Sciences, University of Hertfordshire, College Lane, Hatfield AL10 9AB, Hertfordshire, UK email: D.F.H.Wolke{at}herts.ac.uk
Accepted 8 December
1999
AIMS
To investigate
the effects of small for gestational age (SGA) in very low birthweight
(VLBW) infants on growth and development until the fifth year of life.
METHODSVLBW (< 1500
g) infants, selected from a prospective study, were classified as SGA
(n = 115) on the basis of birth weight below the 10th percentile for
gestational age and were compared with two groups of appropriate for
gestational age (AGA) infants matched according to birth weight
(AGA-BW; n = 115) or gestation at birth (AGA-GA; n = 115).
Prenatal, perinatal, and postnatal risk factors were recorded, and
duration and intensity of treatment were computed from daily
assessments. Body weight, length, and head circumference were measured
at birth, five and 20 months (corrected for prematurity), and at 56 months. General development was assessed at five and 20 months with the
Griffiths scale of babies abilities, and cognitive development at 56 months with the Columbia mental maturity scales, a vocabulary (AWST)
and language comprehension test (LSVTA).
RESULTSSignificant
group differences were found in complications (pregnancy, birth, and
neonatal), parity, and multiple birth rate. The AGA-GA group showed most satisfactory growth up to 56 months, with both the AGA-BW and SGA groups lagging behind. The AGA-GA group also scored significantly more highly on all developmental and
cognitive tests than the other groups. Developmental test results were
similar for the SGA and AGA-BW groups at five and 20 months, but AGA-BW
infants (lowest gestation) had lower scores on performance intelligence
quotient and language comprehension at 56 months than the SGA group.
When prenatal and neonatal complications, parity, and multiple birth
were accounted for, group differences in growth remained, but
differences in cognitive outcome disappeared after five months.
CONCLUSIONSBeing
underweight and with a short gestation (SGA and VLBW) leads to poor
weight gain and head growth in infancy but does not result in poorer
growth than in infants of the same birth weight but shorter gestation
(AGA-BW) in the long term. SGA is related to early developmental delay
and later language problems; however, neonatal complications may have a
larger detrimental effect on long term cognitive development of VLBW
infants than whether they are born SGA or AGA.
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