Background: Intra uterine growth retardation (IUGR) is well recognized to result in infants born small for gestational age (SGA). Early morbidity is followed by increased lifetime risks for health problems, particularly in the 10% of IUGR infants who fail to catch up. Risks include metabolic syndrome with obesity, insulin resistance, abnormal glucose metabolism, hypertension, dyslipidaemia, T2DM. Rapid weight gain in infancy is associated with increased incidence of later obesity, premature adrenarche and PCOS, as precursors of metabolic syndrome. Insulin resistance may be evident by the second year of life. In hospital settings, early care of SGA/IUGR infants is usually provided by neonatologists and general paediatricians. Early gastroenterologic referral for apparent failure to thrive is common. Use of percutaneous gastrostomy is utilized, aiming to improve weight gain. Endocrinology referral is usually later, for poor linear growth and consideration for growth hormone.
Objective and hypotheses: Over feeding of IUGR infants and young children increases linear growth at the expense of signs of early metabolic syndrome. We aimed to provide evidence of adverse metabolic consequences of early over feeding of IUGR children.
Method: Observation of growth parameters, weight distribution and metabolic parameters of 4 PEG fed children, aged 2-4 years with a history of IUGR, referred to an endocrine service for slow linear growth.
Results: Severe central adiposity, buffalo hump and accelerated weight gain far exceeding increase in linear growth was seen in all. Glucose, insulin, lipids, liver function remained in normal ranges.
Conclusion: Extreme caution should be undertaken before PEG feeding of IUGR infants and young children is considered. Careful monitoring is required to prevent onset of features of early metabolic syndrome. Ongoing surveillance is essential as children with rapid weight gain are those at greatest future and long term risk of dyslipidaemia, T2DM, ischaemic heart disease and stroke. It is a responsibility of endocrinologists to adequately inform their colleagues of cautions and special needs of IUGR children.
10 - 12 Sep 2016
European Society for Paediatric Endocrinology