Children born with very low birth weight (VLBW) are at risk of impaired growth. We aimed to study VLBW survivors (90.8%) born in 1998/1999 in the state of Baden-Württemberg (n ϭ 2103) for whom growth data were available up to age six. Classification as appropriate for gestational age (AGA) or small for gestational age (SGA) depended on size at birth. Models to predict height SDS at 5 y were developed using data for 1 yr (Model 1) and 2 yrs (Model 2). The data of 1320 (63%) children were available: SGA: n ϭ 730, AGA: n ϭ 590. At 6 yrs, 8.3% AGA and 13.4% SGA children were short (ϽϪ2.0 SDS). The following factors explained Ht SDS at 5 (and 6) yrs (order of importance): (a) Model 1 (n ϭ 1033; R 2 ϭ 0. A lthough the frequency of premature births has risen during the last decades, the number of surviving babies has risen due to improved perinatal care. This holds particularly true for children with very low birth weight (VLBW; BW Ͻ 1500 g), as their survival rate has reached about 90% (1). Several reports have shown more frequent impairments in growth development in this group in comparison to other prematurely born children with higher birth weights (2-9). After Barker and colleagues established that low birth weight was a major determinant of mortality and morbidity in adult life (10), overwhelming evidence became available from epidemiologic studies which show that impaired birth weight is associated with a higher prevalence of the metabolic syndrome. It has therefore been hypothesized that an impairment in prenatal growth influences the long-term "metabolic programme" of an individual. Several authors have reported that children born small for gestational age (SGA) showed impaired growth in contrast to children whose birth length was appropriate for gestational age (AGA). However the main group studied in these reports involved either children with birth weights higher than 1500 g (11-14) or VLBW children born earlier than 1990 (3,5,6,15,16). Our study of VLBW children was aimed at investigating growth development from birth until early school age and at identifying the factors to predict their height development during childhood. The two birth cohorts we studied derived from the state birth register in Baden-Württemberg in Germany for the years 1998 and 1999, respectively.
METHODS
Population.The state of Baden-Wuerttemberg represents about 10% of Germany's geographical area and approximately 13% of its population. According to the state birth register, there were 108,000 births in 1998 and 111,000 in 1999 (17). Of these, 2316 VLBW babies were born and 2103 (90.8%) of them survived (1). There are 30 neonatal intensive care units (NICU) in Baden-Wuerttemberg, including four university hospitals; and all excepting two small units participated in our study (see Acknowledgements).Data collection. In 2004, birth and follow-up data were available for 2040 (97%) surviving children born VLBW. Parents were sent a questionnaire and a description of the study by post. 1322 (62.9%) families returned the questionnai...