Follow up of children born Small for Gestational Age without catch-up growth at 4 years old at Aalborg University Hospital
Authors
Reynisdóttir, Álfhildur Ösp ; Kristjánsdottir, Kristín Erla
Term
5. Term (Master thesis)
Education
Publication year
2022
Abstract
Children with birth weight or length below −2 SD are defined as small for gestational age (SGA), and those who do not achieve catch-up growth by age four should be evaluated for possible growth hormone therapy. This study aimed to determine, among children born SGA in the Northern Jutland region between 1 October 2016 and 30 September 2017, how many failed to reach catch-up and whether they were referred for pediatric evaluation by age four. Using Maršál growth curves and regional registries, we identified SGA births, excluded foreign citizens, deceased children, children with identifiable syndromes, and duplicate records, and sent a digital questionnaire to 213 families about child height at ages 2, 3, and 4 and parental adult height; data were supplemented with medical record review and managed in REDCap. Of 213 invited families, 40 responded and 37 responses were usable; 7 children had not achieved catch-up, and among these we found 2 who might meet criteria for growth hormone treatment but had not been referred. Medical record review further showed: 116 (53%) not referred with unknown height at age four, 81 (36.8%) not referred with catch-up, 11 (5%) referred with catch-up, 4 (1.8%) referred without catch-up, and 8 (3.6%) not referred without catch-up. In conclusion, some SGA children without catch-up appear not to be referred in a timely manner, but the extent and reasons remain unclear due to low participation and incomplete data. The findings highlight the need for improved registration and sharing of growth data and more systematic follow-up across healthcare settings.
Børn med fødselsvægt eller -længde under −2 SD defineres som små for gestationsalderen (SGA), og hvis de ikke opnår catch-up vækst inden 4-års-alderen bør de vurderes for mulig væksthormonbehandling. Denne undersøgelse havde til formål at identificere, hvor mange SGA-børn født i Region Nordjylland mellem 1. oktober 2016 og 30. september 2017, der ikke opnåede catch-up, og om de var henvist til pædiatrisk vurdering ved 4 år. Vi identificerede SGA ud fra Maršál-vækstkurver og regionale registre, ekskluderede udenlandske borgere, afdøde, børn med syndromer og dubletter, og sendte et digitalt spørgeskema til 213 familier om barnets højde ved 2, 3 og 4 år samt forældres voksenhøjde; data blev suppleret med journaloplysninger og håndteret i REDCap. Af 213 adspurgte svarede 40, hvoraf 37 besvarelser var brugbare; 7 børn havde ikke opnået catch-up, og blandt disse fandt vi 2, der potentielt kunne opfylde kriterier for væksthormonbehandling, men som ikke var henvist. Journalgennemgangen viste desuden: 116 (53%) ikke henvist og med ukendt højde ved 4 år, 81 (36,8%) ikke henvist men med catch-up, 11 (5%) henvist med catch-up, 4 (1,8%) henvist uden catch-up og 8 (3,6%) ikke henvist uden catch-up. Konklusionen er, at nogle SGA-børn uden catch-up sandsynligvis ikke henvises rettidigt, men omfang og årsager kan ikke fastslås på grund af lav svarprocent og ufuldstændig registrering. Studiet peger på behov for bedre registrering og deling af vækstdata samt mere systematisk opfølgning på tværs af sundhedsvæsenet.
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